BIOLCXST 
LIBRARY 


THE  CASE-SYSTEM 
OF  HYGIENE 

BOOK  VII 
DISEASE  PREVENTION 


BY 

HARRY  W.  HAIGHT,  A.B.,  M.D. 

Assistant  in  Hygiene^  Princeton  University 
Instructor  in  Hygiene,  Princeton  Public  Schools 


XOBLE     AND     XOBLE 

76  FIFTH  AVENUE,  NEW  YORK 


a      ji  •   f« 


BIOLOGY 

;;.-     .a 

G 


Copyright,  1916,  by 
HARRY  W.  HAIGHT 

ENTERED   AT   STATIONERS*   HALL 

Reserved 


PREFACE 

(7~o  teachers.) 

The  author  presents  the  following  suggestions  in  regard  to  the 
use  of  this  book  : 

I.  It  is  often  advisable  to  start  a  lesson  by  means  of  a  short 
questionnaire  of  the  last  lesson. 

II.  As  a  rule  a  new  case  should  be  begun  by  writing  it  on  the 
blackboard  or  reading  it  aloud  a  time  or  two  and  by  assigning  it 
for  two  or  three  minutes  intensive  study,  not  expecting  to  secure 
correct  answers,  but  to  promote  thought  and  interest. 

III.  Written  answers  to  the  question  following  the  case  mean 
more  intense,  individual  interest. 

IV.  The  cases  need  not  come  in  exact  rotation.     Skipping 
about  a  bit  secures  unstudied  cases  for  starting  points. 

V.  After  the  presentation  of  the  case  a  verbal  discussion 
should  occur. 

VI.  When  using  the  case-method  instruction  may  be  given 
in  nine  different  ways :    (i)  by  using  the  cases  as  motivating  and 
thought-producing  devices,    (2)    by  verbal   discussion,    (3)    by 
reading,   (4)   by  summary,   (5)   by  notes,   (6)   by  causing  the 
pupils  to  think  twice  (see  below),  (7)  by  review  questionnaire  as 
suggested,  (8)  by  test,  and  (9)  by  examination, — as  time  and 
circumstances  permit. 

The  differing  phases  prevent  monotony  and  secure  thorough- 
ness. 

VII.  The  entire  conception  of  the  case-system  differs  from 
the  conception  of  the  didactic  products,  in  content  quite  as  much 
as  in  method.     A  sincere  effort  has  been  made  to  combat  harm- 
ful, absurd,  and  cynical  prejudices,  such  as  the  ones  that  nothing 

iii 

521645 


iv  PREFACE 

should  be  taught  about  disease  or  symptoms  and  that  pleasing 
sentimentalities  must  be  presented  rather  than  the  concrete, 
every-day  realities  and  existing  conditions  with  which  one  must 
deal  to  secure  action.  Instead  we  have  striven  to  produce  a  work 
which  would,  "move  hands  and  feet  rather  than  tickle  the  ear." 

VIII.  A  good  way  to  measure  the  value  of  the  book  is  to 
check  it  over  page  by  page  noting  the  number  of  places  it  func- 
tions in  experience  where  no  book  of  didactic  conception  does 
function. 

IX.  Too  much  emphasis  can  not  be  placed  on  the  practice  of 
thinking  twice.     Each  child  should  be  lead  by  proper  encourage- 
ment and  instruction  to  think  over  each  case  for  himself  outside 
of  class ;  that  is,  to  recall  what  the  case  was  about ;  to  recall  the 
system  of  the  summary  which  is  the  same  in  each  lesson;   and 
to  piece  the  lesson  together,  as  much  as  he  can  on  that  basis, 
using  pencil  and  paper  in  proper  grades,  before  consulting  the 
book.     Finally  the  pupil  should  be  prepared  to  ask  questions  at 
the  next  lesson,  if  there  are  any  gaps  in  his  knowledge.    Every 
pupil  should  realize  the  importance  of  making  an  effort  to  think 
for  himself  without  consulting  print  when  he  thinks  the  second 
time.     He  should  know  that  what  he  thinks  up  and  thinks  out 
for  himself  on  the  first  review  represents  mastery  and  clear  gain. 
Whereas,  if  he  is  weak  and  lazy  and  never  thinks  twice  or  only 
reads  in  review,  he  loses  part  of  what  he  already  has  and  must 
repeat  and  repeat  before  mastering  the  lesson.    The  process  of 
thinking  twice  is  facilitated  by  the  process  of  thinking  once, 
when  the  case  is  first  presented.     Having  thought  once,  the  pupil 
finds  it  easier  to  think  twice  than  he  would  with  the  old  didactic 
method  which  is  too  often  demoralizing  to  the  mind  and  to  the 
will. 


CONTENTS 

PAGE 

Preface in 

Directions vii 

Introductory  Case 2 

Chapter       I.    The  prevention  of  diseases  easily  spread  by  the 
discharges  of  the  nose  and  throat. 

Case     i.     Prevention  of  a  cold,  and  broncho- 
pneumonia       12 

Case     2.     The  prevention  of  a  cold  and  en- 
larged glands 18 

Case     3.     The  prevention  of  measles   ...  24 

Case     4.     Do 28 

Case     5.     The  prevention  of  scarlet  fever.      .  32 

Case     6.     Do 38 

Case     7.     The  prevention  of  whooping  cough  42 

Case     8.     Do .      .  46 

Case     9.     The  prevention  of  diphtheria     .      .  52 
Case  10.     A  good  contagious  hospital  and  a 

bad  contagious  hospital         .      .  58 

Chapter     II.    The  prevention  of  diseases  less  easily  spread 
by  the  discharges  from  the  nose  and  throat. 

Case  ii.     The  prevention  of  tuberculosis.      .  68 

Case  12.     Do 74 

Case  13.     The  prevention  of  tuberculosis  in 

children 78 

Case  14.     Do «      .      .      .  82 

Case  15.     The  prevention  of  septic  sore  throat  86 

Case  1 6.     Do       .........  92 

Case  17.     The  prevention  of  pneumonia   .      .  98 
Case  1 8.     The   prevention   of  infantile   par- 
alysis      104 

A 


B  CONTENTS 


Case     , 
Case  20 


PAGE 

19.  The  prevention  of  spinal  meningitis     108 

20.  The  prevention  of  glanders  .      .      .114 

Chapter  III.    The  prevention  of  diseases  which  people  get 
from  animals. 

Case  21.  The  prevention  of  malaria  .  .  .  126 
Case  22.  The  prevention  of  plague  .  .  .  132 
Case  23.  The  prevention  of  typhus  fever  .  138 

Chapter    IV.    The  prevention  of  diseases  spread  from  the  sur- 
face of  the  body. 


Chapter  V. 


Case  24. 

The  prevention  of  foot-and-mouth 

disease  

146 

Case  25. 
Case  26. 

The  prevention  of  smallpox. 
The  prevention  of  hand  infection    . 

Ln  <_n 

o\o 

Case  27. 

Do      ......... 

160 

Case  28. 

The  prevention  of  motor  accidents 

and  the  prevention  of  foot  in- 

fection              

1  66 

Case  29. 

The  prevention  of  industrial  acci- 

dents   and    the    prevention    of 

fections      

1  68 

Case  30. 

The  prevention  of  infection  by  for- 

eign bodies  and  the  prevention  of 

tetanus      

172 

Case  31. 

The  prevention  of  trachoma 

176 

Case  32. 

The  prevention  of  ophthalmia  . 

182 

Habit-forming  drugs. 

Case  33. 

Alcohol  and  accidents     .... 

192 

Case  34. 

Alcohol  and  adulterants 

196 

Case  35. 

Alcohol  and  length  of  life     . 

202 

Case  36. 

Alcohol  and  tuberculosis 

2O6 

Case  37. 

Alcohol  and  heredity      .... 

2IO 

Case  38. 

Alcohol  and  insanity       .... 

212 

Case  39. 

Alcohol  and  crime           .... 

216 

Case  40. 

Alcohol  and  school  children 

22O 

Case  41. 

Tobacco  and  soldiers      .... 

224 

Case  42. 

Tobacco  and  Yale  students  . 

228 

Chapter    VI. 

X 

List  of  Illustr; 
Glossary 

CONTENTS 

The  prevention  of  diseases  spread  by  the  dis- 
charges from  the  intestinal  tract.  - 

Case  43.     The  prevention  of  tetanus    . 
Case  44.     The  prevention  of  infant  diarrhoea  . 
Case  45.     The  prevention  of  cholera    . 
Case  46.     Securing  pure  water        .... 
Case  47.     The  prevention  of  typhoid  fever     . 
Case  48.     Unbalanced  ration  and  typhoid    . 
Case  49.     Hookworm    

ations     

C 

PAGE 

234 
238 
242 
248 
252 
262 
27O 

D 
E 
G 

Index 

LIST  OF  ILLUSTRATIONS 


PAGE 


Florence  Nightingale 2 

Broncho-pneumonia 14 

Lymph  gland 20 

Lymphatics  of  head,  neck,  and  chest 21 

Lymphatics  of  hand 22 

Measles,  spots  of 26 

Tuberculin  test 48 

Membrane  of  diphtheria 54 

Tubercular  lung 7° 

Tubercular  sputum 71 

Abscess  of  throat 89 

Pus  in  chest 100 

Meningitis in 

Glanders  bacillus 116 

Enlarged  glands .      .      .      .      .      .  117 

Malarial  parasites. 128 

Mosquitoes 129 

Plague  bacillus 134 

Small-pox IS2 

Small-pox 153 

Vaccination  shield       .      .      .      .      .      .      .      .      .      .      .      •  154 

Tendon  sheathes 158 

Trachoma  bodies 178 

Ophthalmia 184 

Cholera,  germs  of 244 

Typhoid  patches 254 


D 


A  Great  Woman 
Of  whom  is  this  a  picture? 


v  ?: 


BOOK  VII 

INTRODUCTORY   CASE 

The  picture  is  that  of  Florence  Nightingale.  Florence 
Nightingale  was  a  woman  who  lived  in  England  about  fifty 
years  ago.  She  is  famous  because  of  her  work  in  nursing 
and  for  establishing  the  idea  that  it  is  all  right  for  a  woman  to 
do  work  away  from  home.  In  her  time  it  was  thought  highly 
improper  for  a  woman  to  be  engaged  in  any  activity  outside 
of  her  own  home.  Florence  Nightingale  did  not  agree  to  that 
proposition  but  took  up  the  work  of  nursing.  She  studied 
nursing  both  in  England  and  in  France  and  learned  so  well 
that  she  successfully  reorganized  several  hospitals  in  England 
by  the  time  she  was  twenty-eight  years  old. 

When  she  was  thirty-four  years  old  England  was  at  war 
in  Turkey,  waging  the  Crimean  War.  A  good  many  soldiers 
were  being  wounded.  Of  all  of  those  who  were  wounded 
about  64  per  cent.  died.  Florence  Nightingale  thought  it 
would  be  a  very  good  idea  to  collect  a  band  of  nurses  and 
start  for  the  front.  She  did  so  and  took  charge  of  the  nurs- 
ing of  the  soldiers.  She  and  her  nurses  did  their  work  so 
well  that  in  a  short  time  only  2  per  cent,  of  the  soldiers  who 
were  being  wounded  died.  The  Red  Cross  Society  came  as 
a  result  of  her  work.  Since  her  time  the  Red  Cross  Society 
has  looked  after  all  the  soldiers  wounded  in  battle.  Now- 
adays we  look  upon  the  female  nurse  as  an  absolute  necessity. 


BOOK  SEVEN  5 

When  you  remember  that  in  the  time  of  Florence  Nightingale 
she  was  regarded  as  an  impropriety,  you  must  realize  that  the 
human  race  has  a  great  deal  to  thank  Florence  Nightingale 
for. 

The  lesson  that  all  of  you  should  learn  from  her  life  is 
that  a  woman  can  be  great  as  well  as  a  man.  It  is  quite 
true  that  the  work  of  woman  should  be  the  making  of  a 
home.  Every  woman  can  do  work  in  the  science  of 
homemaking  which  of  course  includes  nursing  and  many 
other  things  outside  of  the  home.  This  work  can  be  of 
value  to  every  one  and  may  be  good  enough  to  win  her  wide- 
spread fame. 

The  thing  that  made  Florence  Nightingale  do  the  things 
which  made  her  famous  was  her  ideal.  She  wanted  to  see 
how  much  she  could  do  for  the  human  race  instead  of  how 
much  she  could  get  out  of  it.  I  am  sure  that  most  of  you 
have  that  same  ideal.  Every  girl  and  every  boy  must  turn 
her  or  his  ideal  into  practice.  No  girl  must  be  a  loafer.  She 
must  work  both  in  and  out  of  her  home.  Whenever  she 
has  an  idea  that  she  thinks  would  benefit  other  people,  she 
must  try  it  out  and  not  be  content  to  loaf  along  as  a  great 
many  women  do. 

Women  have  a  great  deal  of  influence  on  the  actions  of 
men.  Some  women  admire  the  sort  of  man  who  is  intent 
only  on  how  much  money  he  can  make.  You  must  admire 
the  sort  of  man  who  tries  to  see  how  much  he  can  do  for  the 
rest  of  the  human  race.  You  must  let  him  know  that  you 
admire  him.  Then  there  will  be  more  men  like  the  scientists 
who  are  working  for  the  good  of  humanity  rather  than  for 
gain. 

The  poet  Longfellow  wrote  a  poem  in  honor  of  Florence 
Nightingale. 


THE  CASE-SYSTEM  OF  HYGIENE 


SANTA    FILOMENA 

Whene'er  a  noble  deed  is  wrought, 
Whene'er  is  spoken  a  noble  thought, 

Our  hearts,  in  glad  surprise, 

To  higher  levels  rise. 

The  tidal  wave  of  deeper  souls 
Into  our  inmost  being  rolls, 

And  lifts  us  unawares 

Out  of  all  meaner  cares. 

Honor  to  those  whose  words  or  deeds 
Thus  help  us  in  our  daily  needs, 
And  by  their  overflow 
Raise  us  from  what  is  low! 

Thus  thought  I,  as  by  night  I  read 
Of  the  great  army  of  the  dead, 
The  trenches  cold  and  damp, 
The  starved  and  frozen  camp, — 


The  wounded  from  the  battle-plain, 
In  dreary  hospitals  of  pain, 

The  cheerless  corridors, 

The  cold  and  stony  floors. 

Lo!  in  that  house  of  misery 

A  lady  with  a  lamp  I  see 

Pass  through  the  glimmering  gloom, 
And  flit  from  room  to  room. 


BOOK  SEVEN 

And  slow,  as  in  a  dream  of  bliss, 
The  speechless  sufferer  turns  to  kiss 

Her  shadow,  as  it  falls 

Upon  the  darkening  walls. 

As  if  a  door  in  heaven  should  be 
Opened  and  then  closed  suddenly, 
The  vision  came  and  went, 
The  light  shone  and  was  spent. 

On  England's  annals,  through  the  long 
Hereafter  of  her  speech  and  song, 

That  light  its  rays  shall  cast 

From  portals  of  the  past. 

A  Lady  with  a  Lamp  shall  stand 
In  the  great  history  of  the  land, 

A  noble  type  of  good, 

Heroic  womanhood. 

Nor  even  shall  be  wanting  here 
The  palm,  the  lily,  and  the  spear, 

The  symbols  that  of  yore 

Saint  Filomena  bore. 


12  THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    I 

Richard  E.,  aged  sixteen  years,  was  in  the  first  year  at 
high  school.  After  school  he  often  had  more  or  less  head- 
ache. The  windows  of  the  schoolroom  were  not  kept  open 
and  the  room  usually  smelled  bad  when  he  came  in  from  the 
outside.  After  school  he  frequently  went  to  a  poolroom  or  a 
cigar  tftore.  He  was  always  clearing  his  throat  and  often 
spat  up  a  bit  of  mucus.  He  had  had  several  colds  each 
winter  as  long  as  he  could  remember.  He  smcked  a  few 
cigarettes  every  day.  On  December  2d  he  commenced  to 
cough  and  his  nose  felt  stopped  up.  He  kept  right  on 
with  his  work.  At  night  he  went  home  and  slept  with  his 
brother  in  a  small,  closed  bedroom.  He  was  afraid  to  open 
the  window  for  fear  of  catching  more  cold.  The  cold  ran 
along  about  the  same  way  until  the  twelfth.  Then  he  began 
to  cough  more;  his  chest  felt  sore;  and  hurt  him  when  he 
coughed.  On  the  fifteenth,  he  was  too  sick  to  go  to  school 
and  seemed  very  feverish. 

What  do  you  think  is  the  matter  with  the  young  man? 


THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    I 

The  stopped-up  nose  and  cough  that  he  had  on  the  second 
of  December  showed  that  he  had  a  cold  at  that  time.  His 
getting  worse  would  make  you  think  the  cold  had  developed 
into  some  sickness  that  was  worse.  The  doctor  was  called 
and  found  that  the  germs  which  were  causing  the  cold  were 
also  attacking  the  lungs.  He  had  a  form  of  pneumonia 
called  broncho-pneumonia  because  the  germs  were  attacking 
both  the  lungs  and  the  bronchi.  You  might  have  suspected 


B.P,  solid  spots  of  broncho  pneumonia;  N,  normal  lung 

A  lung  with  broncho-pneumonia 


BOOK  SEVEN  15 

that  he  had  trouble  in  his  lungs  from  the  sore  chest  and  from 
the  fact  that  it  hurt  him  in  the  chest  when  he  coughed. 

As  you  know,  colds  are  caused  by  germs.  The  germs  are 
spread  when  people  are  crowded  together.  The  germs  that 
cause  colds  start  from  some  person's  throat.  After  a  person 
gets  over  a  cold,  he  may  carry  the  germs  around  in  his  throat 
and  give  them  to  other  people.  It  often  happens  that  chil- 
dren are  the  ones  to  get  them.  The  children  who  are  most 
easily  attacked  are  the  children  who  are  weakest  or  have 
weakened  noses  and  throats.  He  had  weakened  his  nose 
and  throat  by  smoking.  Smoke  irritates  the  nose  and  throat 
and  weakens  them.  He  had  weakened  himself  generally  by 
not  getting  out  and  taking  exercise  instead  of  going  to  a 
poolroom  or  a  cigar  store  and  by  sleeping  nights  with  closed 
windows. 

As  a  rule,  colds  are  not  serious  but,  as  in  this  case,  the  disease 
may  develop  into  something  else  that  is  worse.  Germs,  as 
you  know,  can  travel  to  the  ears,  lungs,  sinuses,  and  glands. 
We  look  upon  colds  as  unimportant,  insignificant  things.  We 
look  upon  ear  trouble,  lung  trouble,  and  sinus  trouble  as 
very  serious  things.  Do  not  forget  that  the  latter  are  only 
colds  continued. 

The  thing  to  do  for  an  ordinary  cold,  if  it  does  not  get 
better  in  four  or  five  days,  is  to  call  a  doctor.  He  can  pre- 
vent some  complications.  An  ordinary  cold  can  be  treated 
at  home  by  remaining  in  bed,  by  taking  a  laxative,  by  eating 
plenty  of  food  which  you  enjoy,  and  by  taking  hot  lemonade 
and  warm  baths  to  help  the  kidneys  throw  off  the  poison 
which  the  germs  are  making.  If  he  had  treated  his  cold  this 
way  when  it  started,  he  would  not  have  had  broncho-pneu- 
monia. 

To  avoid  colds,  you  must  do  two  things,  avoid  germs  and 


i6 


THE  CASE-SYSTEM  OF  HYGIENE 


keep  yourself  in  good  condition.  Three  things  that  do  both 
are  sleeping  with  open  windows,  going  to  an  out-of-door 
school,  and  getting  out  of  doors  to  play.  The  out-of-door 
school  is  a  very  good  thing.  It  makes  schools  more  healthful 
and  permits  less  distribution  of  germs. 
The  boy  recovered  from  his  broncho-pneumonia  in  about  a 


Germs  sometimes  get  from  the  nose  into  the  different  sinuses, 
such  as  the  frontal  sinus  and  the  sphenoidal  sinus 

month.  Afterward  he  stopped  smoking,  started  taking  regular 
exercise,  and  slept  with  his  window  open.  This  illness  had  given 
him  a  close  call  and  a  good  scare.  For  days  he  had  hovered 
between  life  and  death.  Several  times  it  had  been  reported 
that  he  was  dead.  The  next  spring  he  had  a  pair  of  chron- 
ically inflamed  tonsils  removed.  Since  then  he  has  had 
fewer  colds  and  they  have  not  lasted  long. 


BOOK  SEVEN 


SUMMARY   OF    PRACTICAL    POINTS 


I.  Diagnosis. 
II.  Symptoms. 

III.  Cause. 


Broncho-pneumonia. 

1.  Those  of  a  cold. 

2.  Soreness  of  chest. 

3.  Pain  in  chest  upon  coughing. 

1.  General  weakening  by  lack 
of  exercise  and  closed  win- 
dows. 

2.  Air  passages  weakened   by 
smoking. 

3.  Bacteria  attacking  lungs  and 
bronchi. 


IV.  Treatment 


1.  Call  doctor. 

2.  Rest  in  bed. 
Laxative. 
Food. 

Hot  lemonade. 
Warm  baths. 


V.  Preventive  treatment.   Treat  colds  in  early  stage  to 

avoid  complications  such  as 
inflammation  of  the  ears, 
sinuses,  glands,  or  lungs. 


VI.  Prevention. 


1.  Open  windows. 

2.  Out-of-door  life. 

3.  Open-air  schools. 

4.  Avoiding  tobacco. 

5.  Remedying  defects  in  nose 
and  throat. 


i8  THE  CASE-SYSTEM  OF  HYGIENE 


CASE    2 

John  E.,  aged  nineteen  years,  was  an  usher  in  a  moving- 
picture  theatre.  He  began  to  cough  on  November  yth. 
His  nose  discharged  a  little  bit.  His  head  felt  stopped  up 
and  he  felt  out-of-sorts  generally,  as  one  does  with  a  cold. 
For  a  week  he  paid  no  attention  to  his  cold,  save  for  providing 
a  bountiful  supply  of  handkerchiefs.  At  the  end  of  that  time 
he  was  just  dragging  around,  coughing  incessantly,  and  con- 
stantly blowing  his  nose.  On  the  fourteenth,  his  neck  be- 
came stiff  and  was  swollen  on  the  right  side.  He  felt  feverish 
and  more  out-of-sorts  than  he  had  before.  On  the  fifteenth,  he 
had  to  give  up  work.  For  ten  days  he  lay  in  bed  running  a 
temperature  of  about  104  degrees  Fahrenheit.  As  he  lay  in 
bed,  the  stiffness  and  swelling  of  his  neck  increased  and  several 
large  lumps  in  the  neck  became  painful,  red,  hot,  and  swollen. 

What  do  you  think  is  the  matter  with  the  man? 


20 


THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.  2 

This  man  had  a  cold  at  first.  He  had  a  running  nose;  his 
head  felt  stopped  up;  he  felt  out-of-sorts;  and  he  provided 
a  liberal  supply  of  handkerchiefs.  The  swelling  on  his  neck 
on  the  fourteenth  seemed  to  be  something  else.  It  was  a 
swollen  gland  that  had  come  from  the  germs  which  were 
causing  the  cold.  The  germs  had  attacked  various  parts 
of  his  nose  and  throat.  Lymphatics  drain  the  nose  and 
throat  and  empty  into  the  lymph  glands.  The  germs  had 
invaded  the  lymphatics  and  the  lymph  glands. 


A  diagram  of  a  lymph  gland.     You  can  see  how 
the  gland  would  trap  germs 

He  had  probably  gotten  the  germs  that  caused  the  cold  at 
the  moving-picture  theatre  where  he  worked.  The  people 
there  were  crowded  together.  It  was  a  common  source  of 
colds.  The  outlook  for  him  depends  altogether  on  what  he 
does.  If  he  calls  a  doctor  right  away  and  has  the  glands 
attended  to,  he  will  recover. 

A  doctor  was  called,  the  glands  were  incised,  and  a  table- 
spoonful  of  pus  was  allowed  to  drain  out.  He  was  about 


BOOK  SEVEN  21 

three  months  getting  well  and  had  a  close  call  because,  as  you 
see  in  the  illustration,  the  germs  could  very  easily  have 
traveled  down  the  lymphatics  into  his  chest.  Here  they 
would  cause  trouble  in  the  lungs,  and  the  membrane  around 


The  tonsil  drains  into  the  lymphatics  of  the  neck 

the  heart.  If  he  had  gone  to  a  doctor  when  he  first  had  the 
cold"  or  after  the  cold  had  hung  on  four  or  five  days  he 
might  not  have  had  all  the  trouble.  Even  if  he  had  gone  to 
a  doctor  when  the  swollen  gland  appeared  in  the  neck,  appli- 
cations of  antiseptic  solutions  to  the  neck  might  have  kept 
the  gland  from  breaking  down  and  becoming  an  abscess  and 
probably  would  have  prevented  the  germs  from  extending  to 
more  than  one  gland. 


22 


THE  CASE-SYSTEM  OF  HYGIENE 


It  seems  a  great  shame  to  allow  a  public  servant  who  is 
meeting  so  many  people  to  be  carrying  germs  to  all  of  them. 
People  who  have  public  places  of  this  kind  should  be  pre- 
vented from  doing  that  kind  of  work  when  they  have  a  cold. 


Lymphatics  of  the  hand  (after  Sappey).     The  fine  tubes  you  see  running 
everywhere  through  the  hand  are  called  the  lymphatics 

To  prevent  ^  colds  and  other  diseases  like  colds  which  are 
spread  from  the  nose  and  throat,  public  buildings  should  be 
very  carefully  regulated.  They  should  be  cleaned  thoroughly 
each  day  they  are  used  and  the  sunlight  should  be  allowed 
to  play  through  them.  Out-of-door  auditoriums  are  just 
as  good  as  out-of-door  schools.  There  should  be  more 
out-of-door  theatres.  All  public  buildings  should  be  well 
ventilated.  That  does  not  mean  there  should  be  a  hole  in 
the  roof  to  let  air  out  and  an  occasional  opening  along  the 


BOOK  SEVEN  23 

side  to  let  air  in.  There  should  be  a  ventilating  system, 
run  with  a  fan  and  a  motor.  The  air  should  be  pumped 
through  pipes  to  small  ventilators  in  the  floor.  These  small 
ventilators  should  be  located  about  every  second  seat.  Not 
only  should  the  theatres  have  the  apparatus,  but  they  should 
run  it. 


SUMMARY    OF    PRACTICAL    POINTS 


I.  Diagnosis. 
II.  Symptoms. 

III.  Cause. 


IV.  Treatment. 

V.  Preventive  treatment. 

VI.  Prevention. 


Infected  glands  in  neck. 

1.  Those  of  a  cold. 

2.  Swelling,    pain,    heat,    and 
redness  of  glands. 

Cold — Bacteria  attacking  nose 

and  throat. 
Glands — Bacteria         invading 

lymphatics     and     attacking 

glands. 

Incision  of  glands. 

Treat  colds  in  an  early  stage. 

I.  Isolation  of  public  servants 

who  have  colds. 
2.  Care  of  public  buildings. 

a.  Cleaning. 

b.  Sunning. 

c.  Ventilation. 


24  THE  CASE-SYSTEM  OF  HYGIENE 


CASE   NO.    3 

Rachael  P.,  aged  five  years,  began  to  cough  on  October 
2 1  st.  She  had  a  running  nose  and  running  eyes  and  had 
wheezy  sounds  in  her  chest.  She  was  not  sick  enough  to 
stay  in  bed  nor  was  her  appetite  affected.  She  kept  up 
and  played  with  the  other  children.  At  night  all  five  of 
the  children  slept  in  one  room.  On  the  twenty-second,  she 
was  rather  fussy  and  laid  down  most  of  the  time. 

What  do  you  think  is  the  matter  with  the  girl? 


26 


THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    3 

This  little  girl  apparently  has  a  cold.  She  seems  to  have  a 
particularly  weepy  appearance.  Her  eyes  and  nose  are  both 
running  freely.  That  is  thoroughly  characteristic  of  measles 
before  the  rash  comes  out.  There  is  always  a  period  of  two 
or  three  days  at  the  beginning  of  measles  when  the  child 
seems  to  have  only  a  cold.  Then  the  rash  comes  out.  At 
this  time  there  are  often  small  spots  in  the  mouth  which  the 
doctors  can  find.  If  they  do,  they  can  tell  that  the  child 
has  measles. 


A  B 

These  little  spots  are  sometimes  found  on  the  inside  of 
the  cheek  when  measles  is  beginning 

No  one  knows  what  germ  causes  measles.  From  the  way 
the  disease  acts  there  is  little  doubt  that  it  is  caused  by  a 
germ,  but  no  one  has  ever  discovered  this  germ.  There 
is  no  doubt  that  the  nose  and  throat  are  the  first  things 
attacked.  The  disease  is  spread  from  the  discharges 
given  off  by  the  nose  and  throat,  not  from  the  skin. 
The  disease  is  most  catching  in  an  early  stage,  before 
the  rash  has  come  out.  That  is  why,  if  one  child  in  a  family 
gets  measles,  the  others  usually  catch  it  from  that  child. 


BOOK  SEVEN  27 

The  parents  think  the  child  has  a  cold,  while  in  reality  it  is 
in  the  most  contagious  stage  of  measles.  That  is  one  reason 
why  it  is  always  a  good  plan  to  have  a  doctor  look  after  a 
child  when  it  gets  a  cold.  He  can  often  detect  measles  in  this 
stage.  The  spots  in  the  mouth  are  not  always  present.  So, 
if  the  doctor  fails  to  discover  measles  before  the  rash  comes 
out,  he  is  not  to  blame. 

SUMMARY    OF    PRACTICAL    POINTS 

(See  end  of  Case  4) 


28  THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    4 

To  save  expense  these  people  started  to  treat  the  little  girl 
at  home  without  a  doctor. 

Is  there  any  objection  to  home  treatment? 


30  THE  CASE-SYSTEM  OF  HYGIENE 

DISCUSSION — CASE    NO.    4 

The  result  of  home  treatment  was  that  all  four  children 
in  the  family  got  measles.  Three  of  the  children  had  trouble 
with  their  ears  and  one  of  them  was  about  half  deaf  after- 
ward. Instead  of  spending  a  few  dollars  on  measles,  they 
spent  several  hundred  on  ears,  and,  worst  of  all,  the  child  was 
deaf. 

As  you  have  learned  from  previous  cases,  ear  trouble 
can  usually  be  prevented.  In  a  case  of  measles,  it  is  worth 
while  having  a  doctor.  He  can  help  to  prevent  complica- 
tions. 

The  chief  distributing  place  of  measles  is  any  closed  public 
room.  The  one  remedy  in  sight  for  that  is  open-air  rooms. 
Another  remedy  is  the  early  diagnosis  of  measles.  You 
can  see  how  important  the  early  diagnosis  of  measles  is. 
The  early  stage  is  the  most  contagious  part.  That  is  just 
the  time  a  child  with  measles  should  be  discovered  and  kept 
away  from  other  children.  The  only  way  measles  can  be 
kept  from  spreading  in  an  early  stage  is  to  keep  a  child  out 
of  school  the  first  three  days  he  has  a  cold.  As  soon  as  it  is 
noticed  that  a  child  is  sick  with  a  cold  that  child  and  his 
playthings  should  be  isolated  in  a  room  by  themselves. 
Colds  are  most  contagious  then  and  they  may  be  masking 
something  else. 

Measles  is  not  a  harmless  disease.  It  is  apt  to  be  accom- 
panied by  complications  which  will  result  in  permanent  in- 
jury, such  as  deafness,  and  it  is  often  accompanied  by  diph- 
theria and  followed  by  tuberculosis.  Every  child  who  fails 
to  pick  up  promptly  after  measles  should  be  tested  with 
tuberculin  to  see  if  he  is  getting  tuberculosis.  If  he  is, 


BOOK  SEVEN  31 

tuberculosis  will  have  been  diagnosed  in  a  very  early  stage 
and  can  be  treated  successfully.    . 

Measles  is  fatal  to  a  great  many  babies.  Babies  should  be 
kept  from  it  with  great  care.  The  only  way  to  do  that  is  to 
keep  babies  away  from  other  people  just  as  much  as  possible. 
A  child  with  a  cold  ought  never  to  be  allowed  to  go  into  the 
same  room  with  a  baby. 

SUMMARY   OF    PRACTICAL    POINTS 

I.  Diagnosis.  Measles. 

II.  Symptoms.  Early  symptoms. 

1.  Those  of  a  cold. 

2.  Discharge  from  nose  and  eyes. 

3.  Koplick's  spots.  • 
Later — Rash. 

III.  Cause.  I.  Unknown  germ  probably  at- 

tacking nose  and  throat  at  first. 

2.  Later     whole     body    is    af- 
fected. 

3.  Germ    spread    in    discharge 
from  nose  and  throat. 

4.  Germ     spread     in     droplets 
from    noses    and    throats  •  of 
people  who  are  immune. 

IV.  Treatment.  Call  doctor. 

V.  Preventive  treatment,  i.  Early  diagnosis. 

2.  Isolating  children  with  colds. 

3.  Tuberculin  test. 

VI.  Prevention.  I.  Isolating  cases. 

2.  Guarding  babies. 


32  THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    5 

On  the  night  of  March  2ist,  Florence  S.,  aged  ten  years, 
had  a  chill,  vomited,  and  seemed  very  hot.  Her  mother  gave 
her  a  mustard  bath  and  some  quinine.  This  seemed  to 
break  the  fever,  and  made  her  feel  better.  Afterward  she 
had  a  cough.  Her  nose  had  discharged  a  little  bit  and  her 
throat  had  been  sore  for  the  three  preceding  days.  On  the 
twenty-second,  she  seemed  better  and  played  with  several  of 
her  friends  who  stopped  in  after  school  to  see  how  she  was.  On 
the  twenty-third,  she  was  much  more  feverish  and  complained 
of  soreness  in  her  throat.  Several  small  lumps  could  be  felt 
on  both  sides  of  the  neck. 

What  do  you  think  is  the  matter  with  the  girl? 


34  THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    5 

The  little  girl  has  what  seems  like  a  cold  except  that  with 
a  cold  one  does  not  usually  have  a  chill  and  the  glands  in  the 
neck  do  not  usually  enlarge.  Fever  is  not  usually  noted 
when  a  child  has  a  cold.  It  is  seldom  high  enough  to  be 
noticeable  and  is  not  often  discovered  before  a  thermometer 
is  used.  These  symptoms  are  typical  of  the  onset  of  scarlet 
fever.  A  chill,  with  or  without  vomiting,  high  fever,  sore 
throat,  and  enlarged  glands  in  the  neck.  Whenever  the 
child  has  these  symptoms  look  out  for  scarlet  fever  and  isolate 
him  and  anything  he  has  been  playing  with.  It  is  a  good 
plan  to  be  on  the  watch  for  scarlet  fever  whenever  a  child  has 
a  sore  throat  and  to  isolate  the  child.  You  never  can  tell 
whether  it  is  going  to  be  scarlet  fever  or  not.  The  rash  of 
scarlet  fever  came  out  next  day.  The  symptoms  show  that 
the  germs  of  scarlet  fever  were  attacking  her  nose  and  throat. 
That  is  the  place  they  attack  first.  From  there  they  are 
spread. 

No  one  has  ever  discovered  the  germ  that  causes  scarlet 
fever.  There  is  no  doubt  that  the  germs  of  scarlet  fever  are 
carried  around  by  people  who  have  the  disease  and  are  im- 
mune to  it.  These  people  give  it  to  other  people.  Not  every 
person  who  has  had  scarlet  fever  carries  the  germs  of  the 
disease  around  in  his  throat  afterward.  Most  people  do  not. 
The  disease  is  most  catching  in  an  early  stage  while  the  rash 
is  coming  out.  It  sometimes  happens  that  the  germs  get 
into  milk  in  a  dairy.  Then  an  epidemic  of  scarlet  fever  oc- 
curs wherever  the  milk  is  sold. 

The  outlook  in  scarlet  fever  is  never  very  bright.  The 
disease  is  fatal  in  one  case  in  every  eight — in  children  under 


BOOK  SEVEN  35 

five  years  one  in  every  three  or  four.  It  leaves  all  sorts  of 
permanent  injuries  behind.  Injuries  to  ears,  heart,  joints, 
and  kidneys  are  common.  It  is  a  bad  disease.  The  more 
people  who  get  it,  the  more  it  will  spread.  Never  expose  a 
child  to  any  disease  so  that  he  will  have  it  and  be  over  with 
it.  He  may  be  over  with  everything  else,  too.  Prevent  every 
case  you  can. 

As  soon  as  the  mother  saw  the  rash  she  suspected  scarlet 
fever  and  secured  a  doctor.  She  followed  his  directions  and 
the  directions  of  the  Board  of  Health.  Every  one  who  has 
charge  of  a  person  with  scarlet  fever  should  do  the  same  thing. 
A  doctor  can  prevent  a  good  many  complications  in  scarlet 
fever  and  can  make  it  easier  for  the  person  with  it  to  get 
well.  If  you  do  not  follow  the  instructions  of  the  Board  of 
Health  about  isolation,  the  disease  will  spread  and  you  may 
be  responsible  for  the  death  or  injury  of  another. 

Some  people  have  the  idea  that,  if  all  of  the  children  in  a 
family  have  been  exposed  when  one  child  comes  down  with 
measles  or  scarlet  fever,  it  is  not  worth  while  to  keep  the  ex- 
posed children  from  the  sick  child.  That  idea  is  wrong. 
A  child  may  be  exposed  without  getting  the  disease. 

SUMMARY   OF    PRACTICAL   POINTS 

I.  Diagnosis.  Scarlet  fever. 

II.  Symptoms.  A.  Early  stage. 

1.  Chill. 

2.  Vomiting. 

3.  Fever. 

4.  Sore  throat. 

5 .  Swelling  of  glands  of  neck. 
B.  Later — Rash. 


THE  CASE-SYSTEM  OF  HYGIENE 


III.  Cause. 


IV.  Outlook. 


V.  Treatment. 
VI.  Preventive  treatment. 
VII.  Prevention. 


C.  Still  later — Peeling  off  of  skin. 

1.  Unknown  germ  probably  at- 
tacking nose  and  throat  at 
first. 

2.  Later    the    whole    body    is 
affected. 

3.  Germs  spread  in  discharge 
from     patient's     nose     and 
throat. 

4.  Germs    spread    in    droplets 
from   noses    and   throats   of 
people  who  are  immune. 

5.  Germs  spread  in  milk,  some- 
times. 

1.  Over    four   years — fatal    to 
one  in  eight. 

2.  Under  four  years — fatal  to 
one  in  four. 

3.  Many  bad  consequences. 
Call  doctor. 

Obey  Board  of  Health. 

1.  Same  as  colds. 

2.  Vaccine. 


38  THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.   6 

This  girl  was  taken  to  a  hospital  where  she  remained  seven 
weeks.  The  other  children  in  the  family  were  kept  out  of 
school  two  weeks.  None  of  them  had  the  disease  then 
and  it  was  thought  that  they  were  not  going  to  have  it. 
Charles,  the  oldest  boy,  who  was  in  the  eighth  grade,  had  a 
cold  but  was  not  at  all  sick.  So,  they  went  back  to  school. 

Do  you  think  it  is  wise  to  let  the  children  go  back  to  school  ? 


40  THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    6 

It  was  very  foolish  to  let  them  go  back  unless  all  were 
absolutely  well.  Charles  was  having  walking  scarlet  fever. 
He  was  having  the  disease  without  having  any  rash.  That 
often  happens.  Then  the  walker  walks  around  giving  the 
germs  to  others.  He  gave  the  disease  to  eight  others  in  the 
eighth  grade.  Two  of  the  girls  who  had  been  to  visit  Flor- 
ence had  it  and  one  of  them  died.  They  visited  at  just  the 
right  time  to  catch  scarlet  fever.  People  fear  the  scales. 
The  discharges  from  the  nose  and  throat  are  the  things  to  be 
feared.  They  are  present  in  an  early  stage,  the  scales  in  a 
late  stage. 

The  prevention  of  the  disease  depends  upon  an  early  diag- 
nosis of  it.  Unless  the  disease  is  discovered  in  an  early 
stage  the  other  children  in  a  family  are  pretty  sure  to  get  it. 
Therefore,  you  must  know  the  early  symptoms  and  look  out 
for  them.  As  soon  as  the  disease  is  suspected,  the  suspect 
and  anything  he  has  handled  lately  should  be  isolated.  It  is 
a  good  plan  to  keep  any  child  with  a  cold  away  from  the 
other  children.  You  never  can  tell  when  a  cold  is  going  to 
develop  into  something  else.  It  does  no  harm  to  isolate  a 
child  for  a  few  days  and  let  him  out  again,  if  the  disease  fails 
to  develop.  It  may  do  a  lot  of  harm  not  to  as  in  this  case. 
If  this  girl  had  been  isolated  when  she  had  the  chill  and 
vomiting,  the  epidemic  might  never  have  occurred. 

The  Russians  have  a  vaccine  which  they  claim  will  pre- 
vent scarlet  fever.  If  scarlet  fever  is  raging  in  your  neigh- 
borhood, it  might  be  worth  while  to  try  it.  Another  thing 
that  can  be  done  to  prevent  the  disease  is  to  get  pure  milk. 
We  shall  consider  that  question  later.  Another  thing  is  to 


BOOK  SEVEN  41 

have  open-air  schools.  We  have  already  considered  that 
question.  Scarlet  fever  can  be  passed  around  open-air  schools 
as  well  as  closed  schools  but  probably  not  as  freely. 


SUMMARY   OF    PRACTICAL    POINTS 


I.  Diagnosis. 
II.  Symptoms. 

III.  Cause. 

IV.  Treatment. 

V.  Preventive  treatment. 

VI.  Prevention. 


Walking  scarlet  fever. 

1.  Those  of  a  cold. 

2.  History  of  exposure  to  scar- 
let fever. 

Having  scarlet  fever  in  mild 
form  without  having  any 
rash. 

I.  Treat  as  a  dangerous  case 
of  scarlet  fever. 

1.  Early  diagnosis. 

2.  Isolation    of   children    with 
colds. 

1.  Vaccine  used  by  Russians. 

2.  Pure  milk. 

3.  Open-air  schools. 

4.  Isolation  of  cases. 


42  THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    7 

Isabella  C.,  aged  four  months,  was  a  very  cute  baby.  She 
was  such  a  fine  baby  that  her  mother  liked  to  exhibit  her 
at  every  opportunity.  Other  mothers  came  in  practically 
every  day  and  brought  their  children  with  them.  Mrs.  C. 
took  the  baby  to  the  moving  pictures  about  once  a  week. 
On  November  I4th,  the  baby  began  to  cough.  It  coughed 
rather  hard  for  a  minute  or  two  and  then  stopped.  This 
performance  was  repeated  several  times  a  day.  On  the 
fifteenth  and  sixteenth,  the  baby  coughed  harder.  On  the 
seventeenth,  it  vomited  two  or  three  times  after  a  coughing 
spell.  On  the  eighteenth,  it  vomited  in  the  same  way  and 
got  blue  in  the  face  during  the  coughing  spells. 

What  do  you  think  was  the  matter  with  the  baby? 


44  THE  CASE-SYSTEM  _OF  HYGIENE 


DISCUSSION — CASE    NO.    7 

Here  is  another  baby  that  seems  to  be  having  a  cold  but 
there  is  something  that  is  a  little  bit  unusual  for  a  cold. 
When  a  baby  has  a  cold  the  cough  usually  does  not  come  in 
spells.  The  baby  coughs  a  little  now  and  then  but  it  is 
more  or  less  of  a  continuous  performance.  Vomiting  after 
having  a  coughing  spell  is  very  suggestive  of  whooping  cough. 
Getting  blue  in  the  face  during  a  coughing  spell  is  suggestive 
also.  Babies  have  whooping  cough  before  the  whoop  de- 
velops. There  is  an  old  saying  that  a  child  is  two  weeks 
getting  whooping  cough,  two  weeks  having  it,  and  two  weeks 
getting  over  it.  On  the  twenty-fourth,  this  baby  began 
the  whooping  which  comes  with  whooping  cough.  A  child 
sometimes  has  whooping  cough  without  ever  getting  a  whoop. 

A  scientist  by  the  name  of  Bordet  claims  to  have  discov- 
ered the  germ,  the  Bordet  bacillus,  which  causes  the  disease. 
The  disease  like  measles,  scarlet  fever,  and  colds  is  carried 
around  in  the  throats  of  people  who  have  had  the  disease 
and  are  immune  to  it.  It  is  also  spread  from  the  noses  and 
throats  of  children  who  are  having  the  disease.  In  this 
case  the  baby  probably  got  it  from  the  people  who  came  in  to 
visit.  Babies  ought  not  to  receive  many  visitors.  Kissing 
the  baby  should  not  be  permitted  any  one  except  the  parents. 

Whooping  cough  is  very  hard  on  babies.  Babies  usually 
die  if  they  catch  the  disease.  They  get  so  weak  from  the 
paroxysms  of  coughing  that  the  disease  kills  them.  The 
thing  to  do  for  this  baby  is  to  get  a  doctor.  Although  there  is 
no  remedy  that  will  cure  whooping  cough  in  the  way  antitoxin 
will  cure  diphtheria  the  doctor  can  do  enough  to  make  having 
him  worth  while.  He  can  give  the  b aby  medicine  to  make  the 


BOOK  SEVEN 


45 


whooping  and  coughing  less  violent  and  can  see  that  a  binder 
is  properly  adjusted  around  the  child's  abdomen,  so  that  he 
will  not  wrack  himself  so  much  when  he  coughs.  This  baby 
died  on  the  thirteenth. 


SUMMARY   OF    PRACTICAL    POINTS 


I.  Diagnosis. 
II.  Symptoms. 


III.  Cause. 


IV.  Treatment. 

V.  Preventive 

VI.  Prevention. 


Whooping  cough. 

First  stage. 

1.  Paroxysms  of  coughing. 

2.  Vomiting. 

3.  Change  in  cells  of  blood. 
Second  stage. 

I.  Same    symptoms    plus 
whooping. 
Third  stage. 

I.  Same  symptoms.  Whoop- 
ing disappearing. 

1.  Bordet  bacillus  attacks  air 
passages. 

2.  Bacillus      spread      in      dis- 
charge     from      noses      and 
throats. 

3.  Bacillus  spread  in  droplets 
from   noses    and    throats   of 
people  who  are  immune. 

1.  Call  doctor. 

2.  Binder. 

treatment.    Treat  whooping  cough  in  an 
early  stage. 

1.  Isolation  of  case. 

2.  Guarding  babies 


46  THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    8 

In  February  Frank  C.,  aged  eight  years,  started  in  with 
whooping  cough  and  was  sick  with  it  until  the  middle  of 
March.  Whooping  cough  seemed  to  make  him  very  weak 
and  thin.  It  was  now  the  middle  of  May  and  he  did  not 
weigh  as  much  as  he  had  in  January.  He  looked  rather  pale, 
had  a  poor  appetite,  did  not  care  to  play  as  much  as  he  did 
before  he  was  sick.  He  had  been  so  poorly  that  his  parents 
kept  him  out  of  school.  It  seemed  to  his  mother  that  he  had 
not  grown  a  bit  since  the  measles  struck  him. 

What  do  you  think  was  the  matter  with  the  boy? 


48 


THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    8 

In  a  previous  case,  we  have  learned  that,  after  measles, 
tuberculosis  is  very  apt  to  come.  The  same  thing  is  even 
more  true  of  whooping  cough  and  even  more  true  of  the 
combination  of  measles  and  whooping  cough.  This  child 
should  be  tested  with  tuberculin  to  see  whether  he  has  tuber- 
culosis or  not  and  he  should  be  examined  carefully  by  a 
doctor. 

The  child  was  tested  with  tuberculin.  A  little  tuberculin 
was  scratched  into  the  skin  of  his  arm  and  two  other  places 
were  scratched  the  same  way  without  putting  any  tuberculin 
on  them.  In  a  day  the  place  with  the  tuberculin  in  it  became 


A  positive  tuberculin  test 

a  little  red  and  swollen.  The  other  two  places  did  not  change 
at  all.  So,  they  knew  that  he  was  getting  tuberculosis.  Con- 
sequently, he  was  sent  to  a  home  in  the  country  where  he  was 
treated  for  tuberculosis.  In  six  months  he  was  entirely  well. 
That  is  what  happens  in  the  case  of  a  child  who  has  tuber- 
culosis, if  the  disease  is  treated  in  an  early  stage. 

As  you  see,  whooping  cough  often  leads  to  tuberculosis. 
It  is  responsible  for  more  deaths  than  measles  and  scarlet 
fever  put  together.  The  prevention  of  it  depends  on  getting 
it  diagnosed  in  an  early  stage  and  on  isolating  children  with  it 


BOOK  SEVEN  49 

before  they  give  it  to  others.  The  rule  of  always  isolating  a 
child  at  home  who  has  a  cold  will  prevent  trouble  in  the  home. 
Do  not  get  the  idea  that  children  have  to  have  these  diseases. 
The  fewer  children  who  have  them,  the  fewer  deaths  and  de- 
formities there  will  be  from  them. 

We  learned  before  that  an  early  diagnosis  of  whooping 
cough  must  be  made  to  prevent  its  spread.  A  thing  that 
will  help  to  make  an  early  diagnosis  of  the  disease  is  the  blood 
test.  When  a  child  has  whooping  cough,  a  certain  kind  of 
white  cell  in  the  blood  is  increased  in  number.  This  happens 
before  whoops  come.  Every  Board  of  Health  should  be 
prepared  to  make  these  blood  tests  so  that  people  can  have 
them  done  free.  The  people  in  one  western  state  pay  only 
ten  cents  per  person  to  its  Health  Boards  each  year.  If  your 
Health  Board  is  a  ten-cent  Health  Board,  the  chances  are 
that  it  will  not  be  prepared  to  make  such  examinations. 

In  a  short  time  you  will  be  a  voter.  You  can  see  to  it 
that  you  have  a  good  Board  of  Health.  It  will  pay.  If  it 
did  not,  remember  that  people  are  human  beings  and  are  to 
be  placed  above  dollars. 

SUMMARY   OF   PRACTICAL   POINTS 

I.  Diagnosis.  Tuberculosis 

II.  Symptoms.  I.  History  of  whooping  cough 

or  history  of  whooping  cough 
and  measles. 

2.  Loss  of:  weight,  color,  ap- 
petite, growth. 
III.  Cause.  I.  Measles  and  whooping  cough 

lower  child's  resistence. 
2.  Then  germs  of  tuberculosis 
attack  him. 


THE  CASE-SYSTEM  OF  HYGIENE 


IV.  Treatment. 


V.  Preventive  treatment. 


VI.  Prevention. 


1.  Tuberculin  test. 

2.  Out-of-door  life. 

3.  Rest. 

4.  Feeding. 

Tuberculin  test  after  measles 
and  whooping  cough. 

1.  Prevent  measles  and  whoop- 
ing cough. 

2.  Provide    good     Boards     of 
Health. 


52  THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    9 

Robert  C.,  aged  nine  years,  came  to  school  February  9th 
with  a  running  nose  and  a  cough.  On  the  tenth  and  eleventh, 
the  cough  was  worse  and  he  kept  feeling  more  and  more  indis- 
posed. On  the  night  of  the  eleventh,  he  had  difficulty  in  swal- 
lowing and  his  throat  felt  rather  sore.  On  the  twelfth,  he  had 
some  difficulty  in  breathing  and  more  difficulty  in  swallowing. 
He  felt  too  sick  to  get  up  on  the  thirteenth  but  his  father  said  he 
ought  not  to  stay  in  bed  and  give  up  to  a  cold.  So,  he  was 
packed  off  to  school.  The  teacher  noticed  that  he  was  pale 
and  weak  and  too  sick  to  hold  up  his  head.  She  sent  him 
home. 

What  do  you  think  is  the  matter  with  the  child  ? 


54 


THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.   9 

The  child  seems  to  have  a  cold  but  he  is  too  sick  to  have 
only  a  cold.  The  trouble  in  swallowing,  and  having  such  a 
sore  throat,  does  not  go  with  an  ordinary  cold.  A  child  with 
just  an  ordinary  cold  is  not  too  sick  to  get  up.  At  school 
the  teacher  looked  into  the  child's  throat.  She  found  that  a 
gray  substance  extended  like  a  veil  over  the  tonsils  and  soft 
palate.  This  grayish  substance  was  the  membrane  of  diph- 
theria. 

Meanwhile,  the  child  had  been  coughing  the  germs  out 


.  The  membrane  of  diphtheria  in  an  early  stage  and  in  a  late  stage 

of  the  disease 

and  other  children  had  been  breathing  them  in.  Some  people 
are  immune  to  the  germs  of  diphtheria  and  carry  them  in 
their  throat  all  of  the  time.  Such  people  are  called  carriers. 
The  outlook  for  the  boy  depends  altogether  upon  what  is 
done  for  him.  If  he  is  given  antitoxin  right  away,  the 
chances  are  that  he  will  get  well  speedily.  He  was  taken  to 
a  contagious  hospital  and  given  several  doses  of  antitoxin. 


BOOK  SEVEN  55 

The  membrane  had  all  disappeared  in  two  days  and  he  felt 
very  much  better.  Then  the  doctor  at  the  contagious  hos- 
pital started  collecting  germs  from  his  throat  and  growing 
the  germs  in  an  incubator.  For  three  weeks  the  collection 
of  germs  from  the  boy's  throat  always  contained  diphtheria 
germs.  Then  they  decided  to  spray  some  more  germs  of 
another  kind  into  his  throat.  After  these  germs  had  been 
sprayed  in  three  times,  the  germs  of  diphtheria  were  driven 
out.  So,  when  the  boy  went  home,  he  did  not  go  home  to 
carry  diphtheria  germs  to  his  brothers  and  sisters  and  other 
children.  Every  case  of  diphtheria  should  be  treated  with 
antitoxin,  isolated  in  a  contagious  hospital,  and  freed  from 
germs  before  leaving.  When  those  things  are  not  done,  a 
great  many  deaths  will  result. 

A  small  dose  of  antitoxin  heads  off  the  disease  in  exposed 
children.  The  thick  skin  reaction  tells  whether  any  exposed 
child  is  immune  and  needs  the  serum. 

SUMMARY   OF    PRACTICAL    POINTS 

I.  Diagnosis.  Diphtheria. 

II.  Symptoms.  i.  Those  of  a  cold. 

2.  Sore  throat. 

3.  Difficulty  in  swallowing. 

4.  Difficulty  in  breathing. 

5.  Sicker  than  with  a  cold. 

III.  Cause.  i.  Germs  of  diptheria  attack- 

ing nose  and  throat. 

2.  Poison  made  by  germs  cir- 
culating all  over  the  body. 

3.  Germs    spread    from    noses 
and  throats  of  carriers. 


THE  CASE-SYSTEM  OF  HYGIENE 


IV.  Treatment. 
V.  Preventive  treatment. 

V.  Preventive  treatment. 

(continued) 

VI.  Prevention. 


Antitoxin. 

1.  Early  diagnosis  by  means  of 
cultures. 

2.  Early  administration  of  an- 
titoxin. 

1.  Isolation  of  cases. 

2.  Shick  reaction  and  and  anti- 
toxin for  exposed  cases. 

3.  Cultures     from     recovering 
cases. 


58  THE  CASE-SYSTEM  OF  HYGIENE 


CASE   NO.    10 

The  City  of  B.  spent  $20,000  for  a  new  contagious  hos- 
pital. After  the  hospital  was  erected,  a  good  many  children 
who  had  measles,  scarlet  fever,  diphtheria,  and  whooping 
cough  were  sent  there.  Doctors  soon  gave  up  using  the 
hospital  because  they  found  that  a  child  who  was  sent  to  the 
hospital  with  scarlet  fever  was  very  apt  to  get  measles  or 
whooping  cough  before  leaving;  a  child  with  whooping  cough 
was  apt  to  get  diphtheria  or  chicken  pox;  and  so  on.  The 
contagious  hospital  seemed  to  cause  about  as  much  disease 
as  it  prevented.  , 

What  was  the  matter  with  the  contagious  hospital  at  B? 


60  THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    IO 

The  contagious  hospital  at  B.  was  not  conducted  properly. 
They  had  wards.  Wards  in  a  contagious  hospital  are  bad 
things.  At  this  hospital  they  divided  the  cases  up  into  four 
wards.  If  a  case  came  in  with  measles,  it  was  admitted  to 
the  measles  ward  at  once.  Likewise  with  scarlet  fever, 
diphtheria,  and  whooping  cough.  Oftentimes  it  was  found 
that  a  case  that  was  thought  to  be  measles,  in  the  beginning, 
turned  out  to  be  scarlet  fever.  Then  several  of  the  children 
in  the  measles  ward  would  get  scarlet  fever.  The  cases  that 
came  in  with  diphtheria  were  always  developing  some  other 
contagious  disease  later  and  giving  it  to  the  other  children 
in  the  ward.  From  the  time  a  person  catches  the  germs  of 
any  disease  until  it  breaks  out,  there  is  a  period  of  several 
days  or  weeks.  This  period  is  called  the  incubation  period  of 
the  disease  because  the  person's  body  is  incubating  the 
germs.  Children  who  were  admitted  for  one  thing  would 
often  be  incubating  another.  The  children  who  had  measles 
often  had  whooping  cough  before  they  left  and  so  on.  In 
this  way  different  diseases  were  passed  around  very  freely. 

There  are  two  things  that  can  be  done  to  remedy  this 
criss-crossing  of  contagious  diseases  within  a  contagious 
hospital.  One  of  them  is  to  have  separate  admitting  rooms 
where  every  new  case  that  comes  in  stays  by  itself  about 
a  week  until  the  doctors  can  tell  what  the  trouble  really 
is.  Another  thing  is  not  to  have  wards  where  the  children 
are  all  together.  In  the  best  contagious  hospitals,  each 
child  has  a  small  room  to  himself  which  has  glass  walls 
around  it  so  that  any  one  child  can  see  the  other  children  and 
will  not  be  lonely.  At  the  same  time  he  will  not  expose 


BOOK  SEVEN  61 

any  one  else  to  the  disease  he  happens  to  be  having.  If  a 
sick  child  is  lonely,  it  makes  him  worse. 

Contagious  hospitals  are  very  bad  things,  if  they  are  run 
poorly.  If  a  contagious  hospital  has  admitting  rooms  and 
has  no  wards  but  has  separate  rooms  for  each  patient,  it  is  a 
very  good  thing. 

The  home  isolation  of  contagious  cases  is  very  unsatisfac- 
tory. It  keeps  older  people  away  from  their  work  and  the 
other  children  in  the  family  are  almost  always  exposed  and 
infected.  Consequently,  the  loss  in  death  and  deformity 
from  home  isolation  is  greater.  Hospital  isolation  is  better, 
if  it  is  a  good  hospital  isolation.  Otherwise  it  is  worse. 

SUMMARY   OF    PRACTICAL    POINTS 

I.  Diagnosis.  Improperly     conducted      con- 

tagious hospital 

II.  Symptoms.  Cross-infection. 

III.  Cause.  i.  Mistaken  diagnosis. 

2.  Diseases  still  in  incubation 
period. 

IV.  Treatment.  I.  Each    case    in     a    separate 

room. 
2.  Admitting  rooms 

V.  Prevention.  Hospitals  with  separate  rooms 

for  each  case. 

SUMMARY   NO.    I 

The  last  ten  cases  have  all  been  about  contagious  dis- 
eases which  are  easily  passed  from  one  person  to  another  by 
the  discharges  from  the  nose  and  throat.  We  have  studied 


62  THE  CASE-SYSTEM  OF  HYGIENE 

colds,  measles,  scarlet  fever,  whooping  cough,  tuberculosis, 
and  diphtheria.  We  have  learned  what  each  one  of  us  can 
do  to  prevent  these  diseases  and  what  the  community  can 
do  to  prevent  them.  The  first  two  cases  were  about  colds. 
From  them  we  learned  that  colds  are  caused  by  germs  that 
attack  the  nose  and  throat.  The  way  to  prevent  colds  is  to 
keep  yourself  in  good  condition  and  to  avoid  germs.  You 
can  keep  yourself  in  good  condition  by  having  regular  habits, 
especially  those  of  out-of-door  exercise,  eating  and  sleeping; 
by  sleeping  with  your  windows  open;  and  by  avoiding  things 
which  injure  the  nose  and  throat,  such  as  smoking.  The 
germs  that  cause  colds  are  spread  in  crowded  places,  such  as 
street-cars,  theatres,  and  churches.  The  spread  of  germs  in 
these  places  can  be  prevented  by  making  them  as  much  like 
out  of  doors  as  possible.  Another  thing  that  will  keep  down 
the  spread  of  germs  in  these  public  buildings  is  to  wash  the 
buildings  thoroughly  whenever  they  are  used  and  to  disinfect 
them  with  sunlight.  Sunlight  is  a  great  destroyer  of  germs. 
Public  servants  who  have  colds  should  not  be  allowed  to 
spread  them  among  the  audience  in  public  places.  They 
should  keep  away  from  their  places  until  their  colds  are  well. 

A  cold  may  be  a  serious  thing  because  of  the  complications 
which  may  follow  it.  Consequently,  it-is  a  good  plan  not  to 
ignore  a  cold  but  to  treat  it  as  soon  as  it  starts  and  avoid  com- 
plications. 

The  third  and  fourth  cases  were  about  measles.  Most 
people  regard  measles  lightly.  They  think  it  is  a  good  thing 
for  a  child  to  catch  the  disease  and  be  done  with  it.  This  is  a 
great  mistake.  Measles  is  fatal  to  a  great  many  children 
under  five  years  of  age  and  a  goodly  number  who  are  older 
than  that.  It  deforms  a  great  many  more. 

The  only  thing  you  can  do  to  prevent  measles  is  to  avoid 


BOOK  SEVEN  63 

it.  The  reason  it  is  not  avoided  more  is  because  it  is  not 
recognized  more  in  an  early  stage  when  it  is  most  conta- 
gious. The  symptoms  of  measles  before  the  rash  develops 
are  those  of  a  cold  plus  a  very  weepy  appearance.  Every 
child  who  has  a  cold  should  be  kept  away  from  other  children 
for  the  first  three  or  four  days  until  the  parents  can  tell 
whether  the  trouble  really  is  a  cold  or  whether  it  is  measles 
or  some  such  disease.  That  simple  rule  will  keep  the  other 
children  in  the  family  from  getting  infections.  The  same 
thing  applies  to  the  schoolroom.  No  child  should  come  to 
school  the  first  two  or  three  days  it  has  a  cold. 

Good  contagious  hospitals  keep  measles  from  being  spread 
around  the  community.  If  the  child  is  isolated  at  home,  the 
other  children  get  the  disease  as  a  rule  because  home  isola- 
tion is  not  perfect  enough.  Remember  that  tuberculosis 
is  apt  to  follow  measles.  If  a  child  fails  to  pick  up  after 
measles,  have  him  tested  with  tuberculin  to  see  whether  he  is 
in  an  early  stage  of  tuberculosis.  If  he  is,  that  is  the  time 
he  can  be  cured. 

The  fifth  and  sixth  cases  were  about  scarlet  fever.  In 
cases  of  scarlet  fever  it  is  always  well  to  be  on  the  lookout 
for  a  child  with  walking  scarlet  fever.  Children  sometimes 
have  the  disease  without  being  sick  at  all  and  without  having 
any  rash.  They  just  seem  to  have  a  cold.  When  there  has 
been  scarlet  fever  in  the  family  and  one  of  the  children  seems 
to  have  a  cold  keep  him  away  from  other  children  until  the  cold 
is  entirely  well.  Try  to  discover  cases  of  scarlet  fever  before 
the  rash  comes  out.  Sore  throat,  fever,  vomiting,  and  swollen 
glands  should  warn  you.  As  soon  as  you  suspect  any  con- 
tagious disease  isolate  the  child  and  anything  he  has  handled. 

The  seventh  and  eighth  cases  were  about  whooping  cough. 
Whooping  cough  is  very  hard  upon  babies.  Therefore,  keep 


64  THE  CASE-SYSTEM  OF  HYGIENE 

babies  away  from  people,  especially  children  with  colds. 
Remember  that  tuberculosis  is  very  apt  to  follow  whooping 
cough  or  measles  or  the  combination  of  whooping  cough  and 
measles.  If  a  child  fails  to  pick  up  promptly  after  either  of 
these  diseases  or  both  of  them,  have  him  tested  with  tubercu- 
lin and  examined. 

The  ninth  case  was  about  diphtheria.  Antitoxin  cures 
diphtheria.  It  is  effective,  if  administered  early  in  the 
disease.  The  only  way  to  get  cases  of  diphtheria  diag- 
nosed before  the  membrane  appears  is  to  take  a  culture 
from  the  nose  and  throat  of  every  child  who  has  a  cold.  That 
is  worth  doing.  It  ensures  a  careful  examination  of  the  nose 
and  throat  as  well  as  letting  one  know  whether  diphtheria 
germs  are  present  or  not.  Antitoxin  can  also  be  used  to  pre- 
vent disease.  If  one  child  in  a  family  has  it  and  the  others 
have  been  exposed,  the  exposed  ones  can  be  given  a  little 
antitoxin,  if  they  are  not  already  immune.  The  Shick 
reaction  will  tell  you  whether  the  others  are  immune  or  not. 

The  last  case  was  about  a  contagious  hospital,  a  bad  con- 
tagious hospital.  It  was  intended  to  illustrate  the  point 
that  bad  contagious  hospitals  are  bad  things  and  good  con- 
tagious hospitals  are  good  things. 


68  THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    II 

Jeremiah  E.,  aged  twenty-two  years,  caught  a  cold.  He 
kept  right  on  working  in  the  bridge  works,  although  he  felt 
miserable  and  had  a  cough  that  hurt  his  chest  and  wracked 
both  chest  and  abdomen  when  he  coughed.  His  mother 
wanted  him  to  stop  work  when  he  had  been  coughing  for 
about  three  weeks.  She  told  him  that  his  father  had  con- 
tracted consumption  after  a  cold.  He  continued  working 
although  he  found  it  hard  to  do  his  work  and  his  appetite 
was  poor.  At  the  end  of  two  months,  he  was  still  coughing; 
his  appetite  was  very  poor;  he  looked  thin,  haggard,  and 
pale;  and  was  so  weak  that  he  had  to  drag  around  at  his  work. 
He  felt  feverish  at  night  and  was  completely  done  up  by  his 
day's  work  when  he  came  home  in  the  evening.  Formerly 
he  had  felt  like  dancing,  boxing,  skating,  and  things  of  that 
sort  in  the  evening.  He  felt  so  blue  and  melancholy  that 
he  got  into  the  habit  of  stopping  into  a  saloon  on  his*  way 
home  from  work  and  drinking  a  couple  glasses  of  whiskey. 
This  made  him  feel  less  uncomfortable  during  the  evening. 
For  two  months  he  could  not  notice  any  change  in  himself 
and  thought  that  he  was  getting  better. 

What  do  you  think  is  the  matter  with  the  man? 


THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.   II 

Tuberculosis  germs  were  attacking  the  man's  lungs.  The 
cells  in  the  lungs  were  fighting  back  and  as  the  two  waged 
battle,  secretions  were  formed  in  the  lungs  just  about  as  they 
are  when  you  have  a  cold  in  the  head.  They  were  running 
from  the  lungs  somewhat  as  they  run  from  the  nose.  In  the 
illustration  you  can  see  how  the  germs  make  the  lungs  solid 
and  finally  destroy  them.  The  wasting  away  was  due  to  the 


Normal  lung  and  tubercular  lung 

fact  that  the  poisons  made  by  the  germs  which  were  working 
in  his  lungs  were  circulating  to  all  parts  of  his  body. 

Tuberculosis  germs  cause  tuberculosis.  To  finish  a  per- 
son, they  almost  always  have  to  be  helped  along  in  some  way. 
In  this  case,  they  are  helped  along  by  alcohol.  That  often 
happens.  If  the  man  had  not  had  his  senses  taken  away  by 
alcohol,  he  would  have  taken  care  of  himself  in  the  first  place. 


BOOK  SEVEN  71 

He  probably  got  the  disease  while  working  in  a  very 
crowded,  poorly  ventilated  shop,  where  other  men  who  had 
the  disease  would  cough  the  germs  up  into  the  air  which  he 
breathed. 

There  is  nothing  that  will  prevent  tuberculosis  in  the  way 
vaccination  will  prevent  smallpox.  Almost  every  person 
has  had  tuberculosis.  Most  people  have  had  it  in  such  a 
mild  form  that  they  never  knew  it.  It  probably  affected  a 
few  lymph  glands  only.  They  were  in  such  good  condition 
that  they  threw  the  disease  off  right  away.  The  great 


Sputum  containing  tuberculosis  germs 
magnified  1,000  times 

thing  to  do  then  in  preventing  tuberculosis  is  to  keep  in 
good  condition.  Of  course,  it  is  very  foolish  to  expose  your- 
self to  tuberculosis  germs  or  to  allow  people  with  tubercu- 
losis to  scatter  the  germs.  People  who  have  the  disease 
should  be  away  from  other  people,  if  they  are  spitting  up 
germs.  Any  sputum  whatever,  whether  from  tubercular 
or  non-tubercular  people,  should  be  spat  either  upon  the 
earth  or  into  paper  and  then  burned  up. 


72  THE  CASE-SYSTEM  OF  HYGIENE 

Every  one  should  have  pure  air.  Impure  air  in  factories 
and  buildings  should  not  be  tolerated;  nor  should  factories 
be  allowed  to  pollute  the  air  of  the  city.  People  should  not 
be  allowed  to  pollute  one  another's  air  by  being  herded  to- 
gether in  tenements.  Whenever  you  go  to  the  city  you  see 
row  after  row  of  buildings  all  built  next  to  one  another  with 
no  space  between  and  no  yards.  Whenever  you  see  that 
you  may  be  sure  something  is  wrong. 

Every  house  in  which  people  live  should  have  a  space 
around  it  and  a  yard  around  it.  In  cities  there  should  be 
plenty  of  parks  and  the  streets  should  be  broad  with  a  strip 
of  grass  going  down  the  middle  of  the  street. 

A  great  many  people  die  from  tuberculosis.  Most  of 
this  can  be  prevented.  If  you  will  see  to  it  that  people 
are  treated  in  an  early  stage;  that  they  have  a  chance 
to  keep  themselves  in  good  condition;  that  sputum  is 
properly  disposed  of;  and  that  people  are  not  huddled  too 
closely  together,  you  will  prevent  many  cases  of  this  and 
other  diseases. 


SUMMARY   OF    PRACTICAL    POINTS 

I.  Diagnosis.  Tuberculosis. 

II.  Symptoms.  i.  History   of  tuberculosis    in 

family. 

2.  Cough. 

3.  Loss    of:    appetite,    weight, 
color,  and  strength. 

4.  Fever. 

III.  Cause.  i.  Germs    of   tuberculosis    at- 

tacking lungs. 


BOOK  SEVEN  73 

III.  Cause — continued.  2.  Poisons  made  by  germs  cir- 

culating all  over  body. 

3.  Alcohol  also  weakened  the 
man. 

4.  Germs  spread  in  poorly  ven- 
tilated places. 

IV.  Treatment.  i.  Rest. 

2.  Feeding. 

3.  Living  out  of  doors. 

V.  Preventive  treatment.    I.  Early    diagnosis    by    every 

one. 
2.  Early  treatment. 

VI.  Prevention.  i.  Avoid  alcohol. 

2.  Burn  sputum. 

3.  Good  ventilation 

4.  Good  housing. 


74  THE  CASE-SYSTEM  OF  HYGIENE 


CASE   NO.    12 

Let  us  see  what  the  outcome  of  this  case  was. 

The  cough  persisted  and  he  was  still  far  from  being  as 
strong  and  well  as  usual.  About  this  time  he  noticed  that  it 
was  almost  more  than  he  could  do  to  get  through  with  a  day's 
work.  One  of  his  friends  told  him  that  he  ought  to  take  a 
little  drink  before  breakfast  for  his  appetite.  So,  he  got  a 
pint  bottle  of  whiskey  and  commenced  taking  a  drink  before 
breakfast.  For  another  two  months  he  managed  to  keep  up. 
The  cough  persisted  and  the  number  of  drinks  each  day 
became  larger  and  larger.  The  whiskey  made  him  forget 
his  weakness  and  lethargy.  When  he  coughed  it  did  not 
hurt  him  so  much  in  his  chest. 

At  the  end  of  about  seven  months  he  looked  thin  and 
pale,  coughed  frequently,  and  ate  almost  nothing.  At  night 
he  was  so  hot  that  he  frequently  woke  up  wringing  wet  with 
perspiration.  About  this  time  he  was  discharged  from  the 
bridge  works.  He  had  become  drunken  enough  so  that  he 
was  not  at  all  sure  of  getting  his  work  done  or  of  being  at  it 
regularly. 

He  had  been  loafing  around  his  home  and  the  saloon  for 
about  a  week  when  he  had  a  fit  of  coughing.  Suddenly  he 
gulped  up  a  mouth  full  of  blood. 

What  do  you  think  is  the  matter  with  the  man? 


76  THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    12 

The  man  is  having  a  hemorrhage  from  the  lungs.  The 
only  thing  one  can  do  is  to  keep  him  quiet.  Have  him  lie  down 
on  a  sofa  or  bed  and  send  for  a  doctor  at  once.  A  doctor  can 
give  him  a  dose  of  morphine,  which  will  quiet  him  and  will 
make  him  breathe  more  easily.  That  will  cause  the  lungs  to 
move  less  and  there  will  be  less  bleeding.  A  doctor  called, 
gave  morphine,  and  the  bleeding  stopped. 

He  seems  so  weak  that  he  will  probably  die.  He  was 
taken  to  a  sanitarium  where  he  could  live  out  of  doors  and  be 
fed  up.  People  with  tuberculosis  cannot  take  exercise.  Any 
hard  work  tears  them  right  down.  They  have  to  lie  in 
bed  or  sit  in  a  chair  and  eat  a  great  deal  of  food.  He  lived 
only  a  few  weeks  at  the  sanitarium. 

His  first  mistake  was  in  not  paying  attention  to  the 
symptoms  he  had.  If  you  ever  see  a  person  who  has  a  per- 
sistent cough  and  suffers  from  loss  of  weight,  color,  appetite, 
and  strength,  think  of  tuberculosis,  especially  if  there  is  a 
history  of  tuberculosis  in  the  family.  If  it  is  a  child,  remem- 
ber that  they  get  tuberculosis  without  the  cough  but  have 
the  other  symptoms.  When  anybody  coughs  up  blood  sus- 
pect tuberculosis  and  have  him  examined. 

He  might  have  been  saved,  if  he  had  gone  to  a  doctor 
sooner.  At  that  time  only  a  small  patch  of  lung  would  have 
been  affected  and  it  might  have  healed  up  at  a  sanitarium. 

Thousands  of  people  die  of  tuberculosis  just  as  this  man  did 
because  they  fail  to  recognize  the  disease  in  an  early  stage 
and  have  it  treated  then.  You  must  know  the  symptoms 
and  you  must  not  dull  your  brain  with  alcohol  so  that  it  will 
fail  to  recognize  them  when  they  appear. 


BOOK  SEVEN  77 


SUMMARY    OF    PRACTICAL    POINTS 

I.  Diagnosis.  Bleeding  from  lungs. 

II.  Symptoms.  Blood. 

III.  Cause.  Germs    have    destroyed    lung 

and  blood  vessel. 

IV.  Treatment.  i.  Quiet. 

2.  Call  doctor. 

V.  Prevention.  I.  Early  diagnosis   and   treat- 

ment of  tuberculosis. 


78  THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    13 

Walter  Ames,  aged  five  years,  had  been  taken  care  of  by 
his  aunts  for  the  past  three  years  because  the  boy's  mother 
was  in  a  tuberculosis  sanitarium.  For  the  last  two  months 
the  child  had  not  been  quite  as  bright  and  playful  as  usual. 
Formerly,  he  had  been  a  very  bright,  playful  child,  always 
running  around  and  always  full  of  life.  Gradually  he  had 
become  more  and  more  listless  and  he  had  come  more  and 
more  to  lie  around  the  house.  The  aunt  had  been  unable 
to  cook  things  that  he  liked  to  eat.  He  would  not  eat  his 
meals  and  he  seemed  to  look  a  little  bit  thin  and  pale.  A 
friend  told  the  aunt  that  he  could  not  possibly  have  con- 
sumption, as  his  mother  had,  because  he  had  no  cough  and 
was  not  wasting  away  and  was  not  as  pale  as  a  ghost.  She 
told  the  aunt  that  the  only  trouble  was  that  the  child  had 
indigestion  or  had  worms. 

What  do  you  think  is  the  matter  with  the  boy? 


8o  THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    13 

The  loss  of  weight,  strength,  color,  appetite,  and  endur- 
ance should  make  you  suspect  tuberculosis  at  once.  A  child 
seldom  has  a  cough  when  it  has  tuberculosis,  because  the 
germs  seldom  attack  the  lungs.  Usually  they  attack  the 
lymph  glands.  The  child  is  usually  weak  and  sickly  for 
from  four  to  twelve  weeks  and  does  not  grow  as  rapidly  as 
he  should.  Then  he  recovers  Sometimes  the  child  does  not 
get  over  it.  This  was  an  attack  of  the  kind  of  tuberculosis 
children  often  have,  the  kind  in  which  only  the  lymph  glands 
are  attacked.  This  child  was  running  a  temperature;  had  a 
positive  tuberculin  reaction  when  tuberculin  was  scratched 
into  his  skin;  and  had  enlarged  glands  in  his  neck.  He  must 
have  had  tuberculosis. 

Probably  he  got  the  germs  of  tuberculosis  from  his  mother 
who  had  the  disease  in  her  lungs  and  was  coughing  them  up. 
No  matter  how  careful  a  person  is  who  has  the  disease,  if 
he  lives  in  a  house  with  other  people,  he  is  bound  to  give  the 
germs  to  them.  Whether  there  is  anything  about  the  make- 
up of  the  child  of  tubercular  parents  that  would  cause  him  to 
be  more  apt  to  get  the  disease  than  the  child  of  non-tubercular 
parents  we  do  not  know,  but  we  do  know  that  the  former  gets 
it  oftener.  Whether  it  is  only  because  they  are  exposed  more 
to  germs  or  not  we  do  not  know. 

SUMMARY   OF    PRACTICAL   POINTS 

(See  end  of  Case  14) 


82  THE  CASE-SYSTEM  OF  HYGIENE 


CASE   NO.    14 

The  child's  home  was  in  a  thickly  crowded  portion  of  a 
manufacturing  district,  in  the  town  of  C.  The  houses  in 
that  part  of  the  town  were  two  or  three  story  wooden  build- 
ings, closely  crowded  together  with  no  yards  around  them. 
There  were  no  green  lawns.  Everywhere  the  buildings  and 
streets  were  covered  with  black  soot.  The  chimneys  of  the 
factories  poured  smoke  into  the  air  constantly  and  there  was 
always  the  odor  of  the  city  and  the  odor  of  the  factories 
hanging  over  this  neighborhood.  During  the  day  there 
was  a  continuous  clang  and  clatter  of  machinery  to  be  heard. 
During  the  night  many  street  cars  and  wagons  could  be 
heard  on  the  street. 

Why  did  the  child  get  tuberculosis? 


84  THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE  NO.   14 

This  child  might  not  have  had  the  disease,  if  he  had  been 
living  in  a  good  neighborhood.  The  bad  air  and  smell  of  his 
neighborhood  made  him  weak.  Whenever  you  come  across 
a  district  in  the  city  or  country  where  the  smell  of  the  air 
is  bad,  you  can  be  sure  that  that  is  a  bad  place  for  people 
to  live  in.  The  air  we  breathe  ought  not  to  have  enough 
odor  to  notice. 

The  outlook  for  this  boy  depends  altogether  on  what  is 
done  for  him.  If  he  can  leave  the  bad  neighborhood  in 
which  he  has  lived  for  a  while  and  get  fed  up  and  rested,  he 
will  probably  recover.  If  he  is  not  fed  up,  or  if  he  has  to 
stay  in  the  same  place,  he  may  get  so  bad  that  the  germs  will 
attack  his  lungs  and  his  intestines  and  carry  him  off.  He  was 
sent  to  a  home  for  children,  out  in  the  country.  After  living 
in  the  beautiful  country  place  for  four  months,  he  was  com- 
pletely well. 

Here  is  a  case  of  tuberculosis  that  was  discovered  in  an 
early  stage.  The  aunt  did  not  take  the  advice  of  the  kind 
friend  to  get  some  worm  remedy  but  went  to  see  a  doctor 
about  it.  The  doctor  knew  that  the  child  had  tuberculosis. 
In  preventing  the  deaths  which  occur  from  the  disease,  every- 
thing depends  on  having  the  cases  discovered  in  an  early 
stage.  Every  one  must  know  the  symptoms  of  tuberculosis 
in  an  early  stage.  They  are  loss  of  weight,  appetite,  growth, 
endurance,  and  color.  Whenever  they  occur,  find  out  why  by 
consulting  a  doctor. 

As  we  learned  before,  the  only  way  to  prevent  the  disease 
is  to  give  people  a  better  chance  to  keep  in  good  condition. 
One  thing  that  a  good  many  people  can  do  is  to  move  to  the 


BOOK  SEVEN  85 

country,  especially  foreign  people,  who  have  lived  on  farms 
before  they  came  over  here.  Such  people  are  very  poor  city 
dwellers,  and  die  off  rapidly  when  they  live  in  cities.  An- 
other people  who  make  very  poor  city  dwellers  are  the  col- 
ored folks.  They  were  intended  to  live  in  the  country.  In 
cities  they  die  off  very  rapidly. 

SUMMARY   OF    PRACTICAL    POINTS 

I.  Diagnosis.  Tuberculosis. 

II.  Symptoms.  I.  History  of  exposure  to  tu- 

berculosis. 

2.  Loss   of  weight,   color,   ap- 
petite, and  energy. 

3.  Positive  tuberculin  reaction. 

III.  Cause.  I.  Germs    of  tuberculosis    at- 

tacking him. 

2.  Probably     received     germs 
from  tubercular  mother. 

3.  Weakened      by     living     in 
crowded,      dirty     neighbor- 
hood. 

IV.  Treatment.  I.  Living  out  of  doors. 

2.  Rest. 

3.  Feeding. 

V.  Preventive  treatment,    i.  Early  diagnosis  and   treat- 
ment. 

2.  Keep  in  good  condition  all 
of  the  time. 

VI.  Prevention.  Living  out  of  doors. 


86  THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    15 

Ralph  B.,  aged  twenty  years,  had  a  cough  on  the  seventeenth 
of  January.  He  felt  a  little  bit  out-of-sorts  but  not  unusually 
so.  On  the  morning  of  the  eighteenth  he  woke  up  with  a  raw 
feeling  in  his  throat  and  again  felt  rather  bad  but  went 
out  and  milked  ten  cows  at  the  dairy  where  he  was  employed. 
In  the  afternoon  he  felt  worse  and  had  considerable  difficulty 
in  speaking.  His  head  ached  and  he  wanted  to  lie  down. 
His  cough  was  not  very  painful.  His  nose  had  started  to 
run.  On  the  morning  of  the  tenth,  he  could  just  barely  make 
a  sound.  His  throat  was  very  sore,  and  he  felt  so  much  worse 
that  he  could  not  eat  any  breakfast,  but  went  out  and  milked 
his  cows  just  the  same.  He  asked  his  employer  to  let  him 
off  until  he  got  better  but  the  former  said  it  was  just  a  cold 
and  would  go  away  quicker  if  he  kept  on  working.  That 
afternoon  he  milked  again.  At  night  he  could  not  sleep. 
About  ten  o'clock  he  began  to  find  it  hard  to  breathe.  He 
had  completely  lost  his  voice  and  had  a  blinding  headache. 

What  do  you  think  is  the  matter  with  the  man  ? 


88  THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO     15 

The  out-of-sorts  feeling,  sore  throat,  and  running  nose  show 
that  germs  were  attacking  the  man's  nose  and  throat.  The 
loss  of  voice  and  interference  with  breathing  show  that  they 
had  probably  attacked  the  larynx  and  had  made  it  swell  up 
so  that  it  was  hard  for  him  to  speak  or  get  any  air  through  it. 
The  reason  he  feels  out-of-sorts  generally  is  because  the 
poison  of  the  germs  is  circulating  all  over  his  body.  He  has  a 
headache  because  the  poison  is  circulating  to  his  brain,  and 
he  is  sleepless  for  the  same  reason. 

The  outlook  for  him  depends  altogether  on  what  he  does. 
He  should  have  seen  a  doctor  two  days  before  his  throat  first 
felt  sore  and  should  have  had  his  throat  examined  then. 
Several  different  things  can  happen  to  the  throat  that  are 
very  dangerous.  The  throat  may  get  so  stopped  up  that  a 
person  can  no  longer  breathe  but  chokes.  A  doctor  can  both 
remedy  and  prevent  such  things  in  most  cases. 

Of  course,  the  man  who  was  sick  in  this  way  should  not 
have  been  allowed  to  milk  cows.  He  is  constantly  coughing 
the  germs  up  into  the  milk.  Even  if  the  trouble  were  only  a 
cold,  he  might  start  an  epidemic  of  colds.  As  you  have 
learned  before,  what  seems  to  be  a  cold  is  often  a  much  worse 
disease.  Men  who  are  producing  milk  for  people  should  be 
inspected.  Any  who  have  colds  should  be  excluded  from 
the  dairy. 

Whenever  a  person  seems  to  have  a  cold  and  breathes 
as  if  he  had  an  obstruction  in  his  throat,  look  out!  Ab- 
scesses sometimes  form  in  the  back  part  of  the  throat  and 
make  large  swellings  there.  These  swellings  may  shut  off 
the  larynx  and  choke  the  person  or  they  may  burst  and  allow 


BOOK  SEVEN 


89 


pus  and  germs  to  run  down  into  the  lungs.  This  is  especially 
apt  to  happen  in  a  child  who  does  not  know  how  to  describe 
what  is  the  matter  with  it.  Have  a  case  of  that  kind  ex- 
amined by  a  doctor.  He  can  look  down  into  the  throat  and 
see  whether  there  is  an  abscess  or  anything  of  the  kind. 


This  sort  of  an  abscess  in  the  back  of  the  throat 
may  obstruct  breathing 


90  THE  CASE-SYSTEM  OF  HYGIENE 


SUMMARY   OF   PRACTICAL   POINTS 

I.  Diagnosis  Septic  sore  throat. 

II.  Symptoms.  I.  Out-of-sorts. 

2.  Sore  throat. 

3.  Difficulty  in  speaking. 

4.  Headache. 

5.  Cough. 

6.  Discharge  from  nose. 

7.  Difficulty  in  breathing. 

III.  Cause.  I.  Streptococci  attacking  nose, 

throat,  and  larynx. 
2.  Poisons    from    streptococci 
circulating  all  over  body. 

IV.  Treatment.  Call  doctor. 

V.  Prevention.  Keep   sick  people  away    from 

dairy. 


92  THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    l6 

Let  us  see  what  happened  in  the  last  case. 

A  doctor  was  summoned.  He  incised  an  abscess  on  one 
of  the  tonsils  and  evacuated  about  a  tablespoonful  of  pus. 
That  relieved  the  difficulty  in  breathing  and  made  the  man 
feel  better.  On  the  twentieth  he  remained  in  bed.  On  the 
twenty-first  he  was  again  milking.  By  the  twenty-fifth  ten 
people  connected  with  that  dairy  were  in  bed  with  sore  throats. 
By  the  thirtieth  three  hundred  people  in  Boston  had  it.  All 
of  them  were  using  milk  from  this  dairy. 

What  sort  of  an  epidemic  do  you  think  this  was? 


94  THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    l6 

The  streptococcus  of  septic  sore  throat  was  found  in  the 
throats  of  the  people  at  the  dairy,  in  the  milk,  and  in  the 
throats  of  the  people  in  the  town.  Before  the  epidemic  was 
over,  there  had  been  more  than  two  thousand  cases  and  fifty 
deaths. 

The  abscess  in  the  man's  throat  was  not  fatal  to  him;  but, 
as  you  see,  did  lead  to  the  death  of  several  other  people. 
He  got  the  germs  from  his  throat  to  his  hands;  thence,  into 
the  milk  where  they  were  passed  around.  As  other  people 
drank  the  milk,  they  took  the  germs  into  their  throats.  In 
this  way  an  epidemic  was  spread. 

Epidemics  of  various  diseases  are  often  spread  by  milk. 
Consequently,  too  much  care  cannot  be  taken  to  get  pure 
milk.  Several  things  are  done  to  accomplish  this.  One  of 
them  is  the  inspection  of  dairies  by  Health  Board  officials. 
They  attempt  to  see  that  the  dairy  is  properly  made;  that 
the  cows  are  properly  cleaned  before  milking;  that  the  milk- 
ers are  clean  and  take  special  care  about  cleaning  their 
hands;  that  the  milk  is  properly  iced  after  it  is  taken  from  the 
cow;  that  the  milk  is  put  into  sterile  containers  and  shipped 
to  its  destination.  When  the  milk  gets  to  town,  some  cities 
have  it  inspected  again.  They  examine  it  to  see  if  water 
has  been  added.  They  have  it  examined  for  germs  and  take 
the  temperature  of  every  can  of  milk  that  comes  in.  If  the 
temperature  is  high,  the  germs  are  sure  to  be  present  in  great 
numbers.  In  most  milk  there  are  about  100,000  germs  to  the 
cubic  centimeter.  In  the  very  purest  milk  there  are  only 
20,000.  In  impure  milk  there  may  be  from  five  to  seven 
million. 


BOOK  SEVEN  95 

All  of  this  inspection  is  very  much  worth  while  because 
it  does  prevent  a  great  deal  of  sickness.  In  the  olden  days 
when  there  was  no  inspection  of  dairies,  epidemics  were  very 
common. 

Still  another  thing  that  is  done  to  prevent  disease  is  to 
pasteurize  the  milk.  That  is,  after  the  milk  gets  to  town  it  is 
cooked  at  a  certain  temperature  until  all  of  the  germs  in  the 
milk  are  dead.  This  kills  the  germs  and  keeps  them  from 
causing  disease  but  does  not  remove  the  dead  germs.  When 
this  is  done  the  milkman  does  not  have  to  be  as  careful  about 
producing  pure  milk.  Consequently,  the  milk  is  not  as 
good  to  begin  with  and  cannot  be  as  good  to  end  with.  If 
you  suspect  your  milk  is  not  pure,  you  can  pasteurize  it  at 
home  by  putting  the  milk  in  bottles  and  then  putting  the 
bottles  into  a  pail  or  kettle  of  luke-warm  water.  This  kettle 
should  be  allowed  to  heat  over  the  fire  until  it  just  comes  to  a 
boil.  Then  the  kettle  should  be  removed  from  the  fire  and 
the  milk  taken  out  in  five  minutes.  As  soon  as  the  bottles 
can  be  handled,  they  should  be  placed  upon  ice. 

Never  have  any  milk  around  your  house  in  warm  weather 
that  is  not  on  ice.  If  you  do,  the  germs,  which  are  in  all  milk, 
will  grow  very  rapidly  and  the  milk  will  soon  become  im- 
pure. If  you  have  no  regular  icebox,  you  can  make  one  for 
milk  out  of  a  tobacco  pail,  a  can,  and  some  sawdust. 

SUMMARY   OF    PRACTICAL    POINTS 

I.  Diagnosis.  Abscess  of  tonsil. 

II.  Symptoms.  Difficulty  in  breathing. 

III.  Cause.  Enlargement    of    tonsil    ob- 

structed air  passage. 

IV.  Treatment.  Incision  of  abscess. 


THE  CASE-SYSTEM  OF  HYGIENE 


V.  Preventive  treatment. 


VI.  Prevention. 


Keep  people  who  are  sick  away 
from  dairies. 

1.  Prevent  colds. 

2.  Inspect  dairies  and  milk. 

3.  Pasteurize  milk. 


98  THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    17 

Agnes  O'R.,  aged  six  months,  began  to  cough  on  May  I7th. 
She  continued  having  coughing  fits  that  made  her  choke  for 
about  a  month.  For  these  she  received  no  treatment  what- 
ever. About  June  lyth  she  began  to  cough  so  much  at  night 
that  the  parents  could  not  sleep  and  summoned  a  doctor. 
The  doctor  gave  the  parents  a  scolding  for  neglecting  the 
child  and  said  that  it  had  bronchitis  and  was  getting  over 
whooping  cough.  The  medicine  he  left  did  relieve  the  cough- 
ing spells  at  night.  So,  he  was  not  consulted  again.  July 
3d,  the  baby  was  brought  to  the  hospital.  Since  the  doctor's 
visit  on  the  seventeenth  the  baby  had  coughed  less  but  had  had 
an  attack  of  vomiting  on  June  25th.  After  that  it  had  been 
feverish  and  apathetic;  no  longer  kicked  its  bed  clothes  off 
at  night;  and  did  not  cry  to  be  nursed.  The  only  treatment 
it  had  had  was  irregular  nursing  and  rest  in  its  crib.  The 
baby  had  lost  so  much  weight,  color,  strength,  and  brightness 
that  the  parents  were  alarmed. 

What  do  you  think  is  the  matter  with  the  baby? 


100 


THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    I/ 

After  so  much  sickness,  the  baby  may  very  well  have  al  • 
most  anything.  When  it  was  examined  at  the  hospital,  it 
was  found  to  have  pneumonia  and  pus  in  the  chest.  When 
older  people  get  pneumonia  there  is  usually  a  sudden  onset 
with  high  temperature,  a  chill,  and  vomiting.  This  may  not 


Diagram  of  an  X-ray  picture  of  a  collection  of  pus  in 
the  chest,  following  pneumonia 

be  the  case  with  a  child  at  all.  The  disease  may  come  on 
very  gradually. 

Pneumonia  is  caused  by  the  pneumococcus.  A  great  many 
people  have  these  germs  in  their  throats  all  of  the  time.  When 
the  people  are  strong  and  in  good  health,  the  germs  do  no 
harm.  When  people  get  weak,  then  the  germs  attack  them. 

In  a  child  the  outlook  for  a  case  of  pneumonia  is  better 
than  it  is  with  an  adult.  For  some  unknown  reason,  chil- 


BOOK  SEVEN/,  ; 

dren  are  not  as  sick  and  nowhere  near  as  many  of  them  die  as 
do  adults. 

A  doctor  can  accomplish  enough  for  a  case  of  pneumonia 
so  that  it  is  worth  while  having  him.  He  can  prevent  com- 
plications and  manage  the  case  better  than  an  ordinary 
person.  This  baby  almost  died  because  no  doctor  was 
called.  The  collection  of  pus  would  have  resulted  in  death 
in  a  short  time.  If  a  baby  gets  sick,  it  is  a  good  plan  to  get 
a  doctor  and  find  out  what  is  the  matter. 

There  is  no  definite  remedy  that  cures  pneumonia  in  the 
way  antitoxin  cures  diphtheria  or  that  prevents  pneumonia 
in  the  way  vaccination  prevents  smallpox.  All  that  you  can 
do  to  prevent  the  disease  is  to  keep  in  good  condition. 

As  a  citizen,  you  can  see  that  every  one  is  provided  with 
good  opportunities  for  keeping  in  good  health  and  you  can 
see  that  more  research  is  done  on  pneumonia.  You  can  see 
to  it  that  the  liquor  traffic,  smoke  nuisance,  close  housing  of 
people,  the  poor  ventilation  of  buildings  and  the  overheating 
of  buildings  are  prevented.  You  can  see  to  it  that  parks, 
playgrounds,  gymnasiums,  and  baths  are  provided.  All  of 
these  things  will  help  to  prevent  this  disease,  which,  during 
the  course  of  a  good  many  years,  kills  more  people  than  any 
other  one  disease. 

This  baby  had  to  have  a  piece  of  rib  cut  out  to  let  the  pus 
out  of  the  chest.  Pus  ran  out  of  the  hole  several  weeks  but  it 
finally  healed  up  and  the  baby  recovered. 

A  collection  of  pus  of  this  kind  can  follow  any  case  of 
pneumonia  or  broncho-pneumonia.  Always  bear  that  in 
mind,  and  if  a  child  or  any  person  who  has  had  such  a  disease 
fails  to  pick  up  afterward,  have  him  examined.  Collections 
of  pus  such  as  this  also  occurs  in  the  middle  ear;  in  the  various 
sinuses  that  open  off  the  nose;  and  in  some  of  the  glands  into 


102         THE  CASE-SYSTEM  OF  HYGIENE 

which  the  lymphatics  from  the  air  passages  and  lungs  drain. 
A  doctor  can  be  on  the  lookout  for  these  collections  of  pus  and 
can  usually  keep  them  from  doing  a  sick  person  any  harm. 
That  is  one  of  the  chief  reasons  for  having  a  doctor  in  dis- 
eases of  this  kind.  The  only  way  you  can  tell  whether  or  not 
a  collection  of  pus  is  forming  in  those  places  is  to  have  a 
doctor  examine  them. 

Many  scientists  would  like  to  work  out  the  prevention  and 
cure  of  pneumonia.  You  must  provide  them  with  state  or 
private  funds. 

SUMMARY    OF    PRACTICAL    POINTS 


I.  Diagnosis. 
II.  Symptoms. 

III.  Cause. 

IV.  Treatment. 

V.  Preventive  treatment. 

VI.  Prevention. 


Pneumonia. 

Collection  of  pus  in  chest. 

Variety  of  symptoms  coming 
from  the  respiratory  organs. 

Pneumococcus  attacking  re- 
spiratory organs. 

Call  doctor. 

Have  ears  and  *  chest  ex- 
amined when  a  child  has  pneu- 
monia. 

1.  Keep  in  good  condition. 

2.  Abolish  liquor  traffic,  smoke 
nuisance,  close  housing,  poor 
ventilation,  and  overheating. 

3.  Provide  parks,  playgrounds, 
gymnasiums,  and  baths. 

4.  Make  possible  more  research 
by  scientists. 


io4          THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    l8 

Gerald  E.,  aged  four  years,  was  restless  and  feverish 
during  the  night  of  September  loth.  Next  morning  he  did 
not  feel  like  getting  up  and  seemed  to  have  a  cold  coming  on 
as  his  nose  started  to  run  a  little  bit.  He  was  given  a  dose  of 
castor  oil.  On  the  twelfth  and  thirteenth  he  remained  in  bed 
with  no  particular  change  in  condition.  On  the  fourteenth 
he  began  to  complain  of  pain  in  the  right  leg.  The  pain 
continued  through  the  fifteenth.  On  the  sixteenth  the  pains 
were  gone.  He  tried  to  get  out  of  bed  but  could  not  stand  un- 
supported and  fell  when  he  tried  to  walk. 

What  do  you  think  is  the  matter  with  the  little  boy? 


106          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    1 8 

The  fever  and  running  nose  indicate  that  germs  were 
attacking  his  nose.  The  inability  to  stand  indicates  that 
something  was  the  matter  with  his  legs.  A  doctor  was 
called  and  discovered  that  the  right  leg  was  partly  paralyzed. 
The  disease  which  comes  in  children  and  first  attacks  the 
nose  and  throat  while  later  it  produces  paralysis  of  a  part  is 
infantile  paralysis.  In  cases  of  infantile  paralysis,  the  germs 
enter  the  nose  and  throat  and  go  from  there  either  into  the 
blood  or  the  spinal  fluid.  Then  they  get  to  the  spinal  cord. 
Here  they  injure  the  spinal  cord  in  such  a  way  that  impulses 
are  no  longer  sent  to  the  muscles  by  the  nerves  which  go  out 
from  the  spinal  cord.  As  you  have  learned  in  previous  cases, 
when  impulses  no  longer  go  to  the  muscles  and  the  muscles 
fail  to  work  they  are  paralyzed. 

Infantile  paralysis  is  spread  very  much  as  measles  and 
scarlet  fever  are  spread.  The  germs  get  from  one  child's 
nose  and  throat  to  another  child. 

Once  the  disease  has  destroyed  a  part  of  the  spinal  cord, 
nothing  can  be  done  to  repair  the  injury.  After  the  disease 
starts,  a  great  deal  can  be  done  to  keep  the  spinal  cord  from 
being  destroyed  and  to  help  the  child  get  better.  A  child 
with  infantile  paralysis  should  be  kept  in  bed  six  weeks. 
During  this  six  weeks  the  spinal  cord  will  have  a  good  chance 
to  heal  as  much  as  it  will  heal.  At  the  end  of  six  weeks, 
the  paralyzed  limb  should  have  a  massage  treatment  daily. 
The  massage  treatment  is  a  case  of  now  or  never.  If  you 
wait  after  the  six  weeks,  the  massage  does  very  little  good. 
If  the  massage  treatment  is  given  promptly  at  the  end  of  six 
weeks  and  the  child  is  kept  in  bed  six  weeks,  it  often  happens 


BOOK  SEVEN 


107 


that  an  almost  complete  recovery  is  made.  That  was  done 
in  this  case.  The  little  boy  was  kept  in  bed  for  six  weeks 
with  a  splint  on  the  leg  so  that  it  would  not  become  deformed 
while  lying  paralyzed.  At  the  end  of  six  weeks  the  massage 
treatments  were  started.  At  the  end  of  four  months  the 
paralyzed  leg  was  almost  as  good  as  the  other  one. 

The  only  thing  that  can  be  done  to  prevent  infantile  pa- 
ralysis is  to  carry  out  strict  isolation  of  cases  and  strict 
quarantine  of  all  children.  That  means,  in  an  infected  dis- 
trict, each  child,  whether  sick  or  well,  must  not  leave  his 
own  yard. 


SUMMARY   OF    PRACTICAL    POINTS 


I.  Diagnosis. 
II.  Symptoms. 

III.  Cause. 


*IV.  Treatment  and  pre- 
ventive treatment. 

V.  Prevention. 


Infantile  paralysis. 

1.  Those  of  a  cold. 

2.  Pain  along  nerves  of  leg. 

3.  Paralysis  of  leg. 

I.  Germs  of  infantile  paralysis 
attacking  nose,  throat,  and 
spinal  cord. 

1.  Rest  in  bed  for  six  weeks. 

2.  Splints  to  prevent  deformity. 

3.  Daily  massage  treatment. 

1 .  Isolation  of  all  cases. 

2.  Quarantine  of  all  children. 


*Teacher  emphasize  importance. 


io8          THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    19 

Stanley  F.,  aged  ten  months,  vomited  up  his  feeding  on 
July  2Qth,  and  seemed  sick  and  feverish.  At  the  same  time 
he  had  indigestion.  He  was  fed  about  twice  as  much  as 
usual  because  he  cried  and  seemed  thirsty.  On  July  2ist, 
he  did  not  cry  as  much  and  seemed  drowsy.  The  fever  and 
indigestion  continued.  He  vomited  several  times  that  day. 
From  the  twenty-first  to  the  twenty-fifth  his  condition  did 
not  change  except  that  he  became  more  and  more  drowsy 
and  difficult  to  arouse.  The  only  treatment  had  consisted  of 
pills  to  stop  indigestion. 

What  do  you  think  is  the  matter  with  the  child? 


no          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    19 

The  child  seems  to  have  indigestion  except  that  he  is  very 
drowsy.  Children  who  have  indigestion  are  drowsy  some- 
times but  usually  they  are  wide  awake  and  anxious  and  cry 
a  great  deal.  The  increasing  drowsiness  ought  to  make 
you  think  there  was  something  the  matter  with  his  brain. 
At  the  hospital,  the  doctors  discovered  all  the  signs  of  brain 
trouble.  He  had  a  stiff  neck,  a  slow  pulse, 'the  pupils  in  his 
eyes  would  not  open  and  close  when  light  was  thrown  on 
them  and  he  had  no  knee  jerks.  Other  signs  were  also 
present.  Doctors  can  often  get  a  good  deal  of  information 
about  brain  trouble  by  drawing  off  some  of  the  spinal  fluid 
which  as  you  know  bathes  the  brain.  In  this  case,  they 
removed  some  of  the  spinal  fluid  by  tapping  the  spinal  canal 
low  down  in  the  back.  The  fluid  was  full  of  pus  and 
contained  the  germs  of  spinal  meningitis.  We  mean  by  the 
term  spinal  meningitis  an  inflammation  of  the  meningies  or 
membrane  surrounding  the  brain  and  spinal  cord.  As  you 
can  see  from  the  illustration,  pus  and  germs  run  from  the 
inflamed  membrane  and  get  onto  the  brain. 

The  disease  is  spread  in  just  about  the  same  way  that  infantile 
paralysis  and  measles  are  spread.  Flexner's  serum  is  a  cure  for 
most  cases  of  the  disease,  if  it  is  given  in  an  early  stage.  The 
only  thing  you  can  do  to  get  cases  treated  in  an  early  stage  is 
to  have  doctors  examine  children  when  they  have  colds  or 
what  seem  to  you  to  be  colds.  The  same  measures  that  pre- 
vent colds  will  prevent  spinal  meningitis.  Not  only  does  the 
early  administration  of  Flexner's  serum  cure  the  disease  but 
it  prevents  the  hideous  deformities  which  the  disease  pro- 
duces otherwise.  If  a  case  of  spinal  meningitis  is  allowed  to 


BOOK  SEVEN 


in 


run  on,  the  inflammation  extends  from  the  membrane  around 
the  brain  to  the  brain  itself.  Then  all  sorts  of  deformities 
follow  depending  on  what  part  of  the  brain  was  affectedc 
If  the  part  that  controls  the  eye  is  affected,  the  child  may  be 


Pus 


fi/s 


On  the  left-hand  side  you  see  the  inflamed  dura,  the  membrane  which 
surrounds  the  brain.  On  the  right-hand  side  the  dura  has  been  cut  away. 
You  can  see  how  pus  and  germs  from  the  dura  get  to  the  brain  when  the 
dura  is  inflamed. 

blind.  If  the  part  that  controls  the  ear,  deaf.  Enough  of 
the  brain  may  be  injured  to  make  an  idiot  out  of  the  child. 
Therefore,  it  is  well  to  have  every  child  who  has  a  cold  ex- 
amined by  a  doctor.  That  procedure  as  you  have  seen  will 


ii2          THE  CASE-SYSTEM  OF  HYGIENE 

result  in  getting  a  great  many  different  children's  diseases 
diagnosed  and  treated  in  an  early  stage. 

This  baby  was  so  far  gone  that  he  died.  This  case  shows 
what  doctors  can  tell  when  they  examine  a  person  who  is  sick. 
In  this  case  the  trouble  with  the  brain  made  changes  in  the 
way  the  nerves  reacted.  Only  a  doctor  could  tell  what  these 
changes  were.  The  pupils  of  the  eyes  did  not  react  to  light. 
Usually  when  you  hit  the  large  cord  in  front  of  the  knee,  the 
lower  leg  will  jerk.  That  is  because  the  nerves  react  from 
the  blow  you  strike  the  knee.  This  act  is  called  the  knee 
jerk.  It  was  absent  in  this  case.  When  things  get  the  mat- 
ter in  the  chest,  the  sounds  made  by  the  lungs  and  the  heart 
are  changed.  A  doctor  can  distinguish  these  changes  by 
using  a  stethoscope.  When  things  get  the  matter  in  the 
abdomen,  the  condition  of  the  abdomen  will  be  changed. 
It  will  be  held  more  rigidly  and  there  may  be  masses  to  feel  in 
it.  Only  a  doctor  can  tell  whether  the  condition  is  normal  or 
abnormal,  and  so  it  goes  for  all  parts  of  the  body.  A  doctor 
can  tell  the  difference  between  normal  and  abnormal.  Un- 
less the  difference  is  very  marked,  the  average  person  can- 
not do  so.  You  need  not  remember  what  these  various 
changes  are  but  you  must  appreciate  that  a  doctor  can  often 
tell  abnormal  from  normal  when  you  cannot. 


SUMMARY   OF    PRACTICAL    POINTS 

I.  Diagnosis.  Spinal  meningitis. 

II.  Symptoms.  i.  Appearance  of  being  sick. 

2.  Fever. 

3.  Vomiting. 

4.  Drowsiness. 


BOOK  SEVEN 


II.  Symptoms — cont. 

III.  Cause. 

IV.  Treatment. 

V.  Preventive  treatment. 


5.  When  examined,  signs  that 
came  from  brain  trouble. 

6.  Meningococci  in  spinal  fluid. 

Meningococci  attacking  brain. 

1.  Lumbar  puncture. 

2.  Flexner's  serum. 

1.  Early  diagnosis. 

2.  Early  administration  of  Flex- 
ner's  serum. 


ii4          THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    20 

George  D.,  aged  twenty-seven  years,  a  teamster,  knew 
that  there  were  several  sick  horses  in  the  barn  where  he 
worked.  One  of  his  horses  had  a  discharge  from  the  nose 
and  did  not  seem  as  ambitious  as  usual.  In  a  week  the  horse 
was  so  sick  that  he  could  not  work  at  all.  The  discharge 
from  the  nose  was  worse.  Many  small  lumps  had  appeared 
under  the  skin  of  the  front  legs  and  at  the  place  where  the 
front  legs  joined  the  body.  About  this  same  time,  the  seventh 
of  October,  George  D.  began  to  feel  a  little  bit  out-of-sorts 
himself.  He  had  a  headache,  and  a  pain  in  his  right  leg. 
On  the  second  day  he  felt  feverish  and  so  much  out-of-sorts 
that  he  stayed  in  bed.  On  the  third  day  his  landlady  found 
that  he  was  a  little  bit  out  of  his  hea:d.  He  lay  in  bed  and 
kept  insisting  that  the  fire  department  was  going  to  take  his 
horses.  A  doctor  was  called  in.  He  noticed  that  the  man 
had  much  discharge  from  his  nose  and  had  several  small 
lumps  in  his  armpits  and  over  his  arms. 

What  do  you  think  is  the  matter  with  the  man? 


ii6          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    2O 

The  symptoms  of  a  discharge  from  the  nose,  general  ill- 
ness, and  having  little  glands  swell  up  under  the  skin  is 
typical  of  glanders  in  horses.  The  disease  can  be  transmitted 
to  men.  If  you  will  notice,  the  man  had  almost  exactly  the 
same  symptoms  as  the  horses.  He  had  a  discharge  from  the 
nose;  was  sick  with  a  fever;  and  had  glands  swell  up 
under  the  skin  of  his  armpits,  arms,  and  groins.  He  was 
removed  to  the  hospital  and  died  in  forty-eight  hours. 
Autopsy  showed  that  the  germs  which  cause  glanders  were 
swarming  in  the  glands  that  had  swollen  up. 


The  glanders  bacillus 

He  had  undoubtedly  caught  the  germs  of  glanders  from 
the  horses.  He  either  breathed  them  in  around  the  stable 
or  had  gotten  them  on  his  ringers  and  then  into  his  mouth. 
Horses  get  the  disease  from  a  common  watering  trough.  If 
one  horse  drinks  from  the  trough,  he  gets  the  germs  into  the 
water.  Then  all  of  the  horses  get  them. 

Once  a  man  or  a  horse  has  the  disease,  very  little  can  be 
done  for  him.  The  great  hope  lies  in  prevention. 

The  disease  can  be  prevented  in  horses  by  not  having 
common  watering  troughs.  That  is  why  most  stables  use  pails 
nowadays,  each  horse  having  its  own  pail.  After  the  disease 
breaks  out,  animals  with  it  should  be  destroyed  to  keep  the 
disease  from  spreading  to  other  animals.  The  disease  is 


BOOK  SEVEN 


117 


very  rare  among  people.     The  only  people  who  get  it  are 
men  who  take  care  of  horses.     They  can  avoid  it  by  being 
careful  with  sick  horses.     So  many  horses  are  destroyed 
by  the  disease  that  there  is  no  doubt  that  public  and  com 
men  watering  troughs  should  be  abolished. 


In  a  case  of  glanders  the  lymph  glands  all  over 
the  body  enlarge  in  this  way 


THE  CASE-SYSTEM  OF  HYGIENE 


SUMMARY    OF    PRACTICAL   POINTS 


I.  Diagnosis. 
II.  Symptoms. 


III.  Cause. 


IV.  Treatment. 
V.  Prevention. 


i.  Glanders. 

1 .  History  of  sick  horses. 

2.  Out-of-sorts. 

3.  Headache. 

4.  Pain  in  leg. 

5.  Fever. 

6.  Delirium. 

7.  Discharge  from  nose. 

8.  Enlarged  glands. 

1.  Glanders    bacilli    attacking 
nose  and  glands. 

2.  Poisons   from   germs   circu- 
lating all  over  body. 

i.  Rest  in  bed. 


Abolish  common  watering 
troughs. 

Destroy  animals  with  the 
disease. 


SUMMARY   NO.    2 

The  last  ten  cases  have  all  been  about  diseases  that  are 
spread  by  discharges  from  the  nose  and  throat.  We  have 
considered  tuberculosis,  septic  sore  throat,  pneumonia,  in- 
fantile paralysis,  spinal  meningitis,  and  glanders.  The 
preceding  group  was  also  about  diseases  that  were  spread 
from  the  discharges  of  the  nose  and  throat.  The  diseases 
of  that  group  are  spread  more  easily  than  those  of  this  group. 

Different  measures  must  be  taken  to  prevent  each  one  of 


BOOK  SEVEN  119 

these  diseases  because  the  diseases  are  spread  in  different 
ways  and  must  be  handled  in  different  ways. 

From  the  first  two  cases,  those  of  the  man  who  got  tubercu- 
losis in  a  crowded  factory  and  became  worse  because  alcohol 
robbed  him  of  his  senses,  we  may  learn  several  general  lessons. 

1.  Almost   every   person   has   had    tuberculosis   but    has 
thrown  it  off,  because  he  was  in  good  condition. 

2.  Proper  housing,  a  chance  to  keep  in  good  condition, 
and  good  ventilation  of  buildings  will  do  a  great  deal  to  pre- 
vent the  disease. 

3.  Proper  disposal  of  sputum  will  also  help  to  prevent  the 
disease. 

4.  Most  cases  of  tuberculosis  can  be  prevented  from  caus- 
ing death,  if  they  are  treated  in  an  early  stage. 

5.  Cases  of  tuberculosis  will  not   be  cured   in   an   early 
stage  unless  you  learn  the  early  symptoms  of  tuberculosis 
and  see  that  suspected  cases  are  examined  by  a  doctor. 

6.  The  early  symptoms  of  tuberculosis  are  loss  of  weight, 
color,  endurance,  and   appetite.     There  may  be  fever  and 
coughing  up  of  blood.     Adults  have  a  cough. 

7.  Alcohol  helps  the  germs  of  tuberculosis  to  kill. 

8.  In  case  of  a  hemorrhage  from  the  lungs,  keep  the  per- 
son quiet  and  send  for  a  doctor. 

The  third  and  fourth  cases  were  about  a  child  who  had 
tuberculosis.  We  learned  from  them  that  almost  the  only 
difference  between  tuberculosis  in  a  child  and  an  adult  is 
that  the  child  has  no  cough  and  usually  gets  over  the  disease 
before  any  one  finds  out  that  he  has  had  it,  especially  if  he 
gets  a  chance  to  go  to  the  country  where  he  can  have  fresh 
air  and  good  food. 


120          THE  CASE-SYSTEM  OF  HYGIENE 

From  the  fifth  and  sixth  cases,  those  of  the  milkman  who 
started  an  epidemic  of  septic  sore  throat,  we  may  learn  sev- 
eral general  lessons.- 

1.  Septic  sore  throat  is  a  disease  transmitted  by  means  of 
milk. 

2.  Septic  sore  throat  may  be  prevented  by  pasteurizing 
the  milk. 

3.  Pure  milk  is  better  than  pasteurized  milk. 

4.  Pure  milk  may  be  secured  by  having  the  dairies  prop- 
erly inspected,  by  having  the  milkers  inspected,  and  by  having 
the  milk  properly  inspected  after  it  gets  to  town. 

5.  Milk  can  be  pasteurized  at  home. 

6.  Milk  should  be  kept  on  ice  in  warm  weather. 

7.  Store  milk  is  apt  to  be  impure. 

8.  Certified  milk  is  apt  to  be  pure. 

From  the  seventh  case,  that  of  the  baby,  who  had  pneu- 
monia and  pus  in  the  chest,  we  may  learn  several  general  lessons. 

1.  Pneumonia  kills  more  people  than  any  other  one  disease. 

2.  The  germs  of  pneumonia  are  in  people's  throats  and 
noses  all  of  the  time. 

3.  The  only  thing  a  person  can  do  to  prevent  pneumonia 
is  to  keep  in  good  condition. 

4.  Pneumonia  is  not  as  hard  on  children  as  on  adults. 

5.  As  a  citizen  you  can  see  to  it  that  every  one  has  a  good 
chance  to  keep  in  good  condition;  that  is,  you  can  help  to 
abolish  the  liquor  traffic,  the  smoke  nuisance,  the  close  hous- 
ing of  people,  the  poor  ventilation  of  buildings,  the  over- 
heating of  buildings,  and  you  can  help  to  establish  parks, 
playgrounds,  gymnasiums,  and  baths. 

From  the  eighth  case,  that  of  the  little  boy  who  got  in- 
fantile paralysis,  we  may  learn  several  general  lessons. 


BOOK  SEVEN  121 

1.  Infantile  paralysis  produces  a  great  many  cripples. 

2.  Infantile  paralysis  is  spread  in  about  the  same  way 
measles  is  spread. 

3.  Infantile  paralysis  can  be  prevented  by  isolation. 

4.  Once  the  child  has  the  disease,  proper  treatment  will 
make  the  recovery  more  certain  than  improper  treatment. 

5.  Proper  treatment  consists  of  a  rest  of  six  weeks  in  bed, 
and  then  massage  treatments  every  day. 

From  the  ninth  case,  that  of  the  little  boy  who  had  spinal 
meningitis,  we  may  learn  several  general  lessons. 

1.  Spinal  meningitis  is  an  inflammation  of  the  membrane 
around  the  brain  and  spinal  cord. 

2.  The  disease  is  spread  in  about  the  same  way  infantile 
paralysis  is  spread. 

3.  The  disease  can  be  prevented  only  by  isolation  in  an 
early  stage. 

4.  Flexner's  serum  will  cure  the  disease,  if  given  in  an  early 
stage. 

5.  The  only  way  cases  can  be  cured  in  an  early  stage 
is  to  have  children,  who  seem  to  have  colds,  examined  by  a 
doctor. 

6.  If  the  disease  is  allowed  to  damage  the  brain,  all  sorts  of 
deformities,  such  as  idiocy,  blindness,  and  deafness  are  pro- 
duced. 

From  the  tenth  case,  that  of  the  man  who  got  glanders 
from  his  horses,  we  may  learn  several  general  lessons. 

1.  Glanders  is  a  disease  of  horses.     It  kills  a  great  many 
thousand  dollars'  worth  of  horses  every  year. 

2.  It  is  spread  from  the  noses  of  the  horses  at  common 
watering  troughs. 


122          THE  CASE-SYSTEM  OF  HYGIENE 

3.  The  disease  can  be  prevented  by  abolishing  public  and 
common  watering  troughs. 

4.  Once  the  disease  has  broken  out  animals  with  it  should 
be  destroyed. 

5.  The  only  people  who  get  it  are  horsemen. 

6.  They  can  avoid  the  disease  by  taking  precautions  when 
around  sick  horses;  such  precautions  as  keeping  the  hands 
clean,  and  wearing  rubber  gloves. 


126          THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    21 

Theodore  C.,  aged  seven  years,  at  noontime  on  the  seventh 
of  July  had  a  feverish  attack  and  shook  all  over.  He  did 
not  go  down  to  the  creek  and  play  that  afternoon  as  usual. 
That  night  and  the  next  night  he  slept  rather  poorly  because 
he  was  bitten  so  many  times  by  mosquitoes.  On  the  eighth  he 
was  around  playing  as  usual.  About  ten  o'clock  on  the  ninth 
his  mother  noticed  that  he  came  in  and  laid  down  on  the 
sofa.  In  a  little  while  he  began  to  get  red  and  hot.  His 
teeth  chattered.  He  shook  all  over.  Then  he  became  pale 
and  burst  into  a  cold  sweat.  He  repeated  this  three  times 
in  the  next  ten  minutes  and  then  went  to  sleep. 

What  do  you  think  is  the  matter  with  the  boy? 


128         THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    21 

Chills  and  fever  used  to  be  the  name  for  malaria  but  they 
also  come  at  the  onset  of  other  diseases.  In  any  such  case, 
the  thing  to  do  is  to  get  a  doctor.  In  this  case  the  doctor 
found  the  parasites  of  malaria  in  the  blood  as  you  may  see  in 
the  illustration. 

The  parasites  of  malaria  are  tiny  one-cell  animals.  They 
get  into  a  person  when  he  is  bitten  by  mosquitoes  who  happen 
to  be  carrying  the  parasites  of  malaria  in  their  mouths.  You 
can  tell  the  malarial  mosquito  from  the  ordinary  mosquito  by 


The  parasites  of  malaria  multiplying 

tVip  reH  hlooH  rells 


the  red  blood  cells 


in 


looking  at  its  wings.  The  ordinary  mosquito  has  straight 
ribs  in  his  wings  while  the  malarial  mosquito  has  spots  on  his 
wings  as  you  may  see  in  the  illustration.  Not  all  mosqui- 
toes carry  malaria. 

When  the  parasites  get  into  the  blood,  they  multiply 
rapidly.  In  a  short  time  they  become  millions.  Swarms 
of  them,  circulating  in  the  blood,  cause  the  chills,  fever,  and 


BOOK  SEVEN 


129 


headache  and  the  general  feeling  of  sickness  that  a  person 
has  when  he  has  malaria. 

Quinine,  properly  given,  will  cure  malaria.  It  took  only 
six  grains  to  cure  this  boy.  If  you  live  in  a  country  where 
there  is  much  malaria,  you  will  know  that  a  great  many  peo- 
ple who  have  had  malaria  do  not  stay  cured  after  taking 
quinine.  That  is  because  there  is  a  form  of  the  parasite  in 
the  blood  which  can  be  reached  only  by  taking  one  grain  of 
quinine  every  hour  for  four  hours  preceding  the  hour  at 
which  the  last  chill  came.  This  must  be  done  every  seventh 
day  for  seven  days  from  the  day  of  the  last  chill. 

The  reason  for  this  treatment  is  because  this  form  comes 


How  can  you  tell  the  ordinary  mosquito,  the  malarial  mosquito,  and  the 
yellow-fever  mosquito  apart?  The  second  mosquito  is  the  ordinary  mos- 
quito, the  first  is  the  malarial  mosquito,  the  third  one  the  yellow-fever 
mosquito. 

out  into  the  blood  where  quinine  will  reach  it  only  every 
seventh  day.  This  treatment  was  invented  by  Bass  of  New 
Orleans.  There  is  no  doubt  that  it  does  cure  a  great  many  of 
these  chronic  cases  of  malaria.  When  you  get  to  be  voters, 
you  should  see  to  it  that  Bass  and  men  like  him  are  given  re- 
wards of  money,  have  statues  erected  to  them  in  public  places, 
and  get  a  permanent  place  in  history.  The  progress  of  the 
world  is  largely  made  by  these  scientists  who  make  important 
discoveries. 


1 30          THE  CASE-SYSTEM  OF  HYGIENE 

The  disease  was  prevented  almost  entirely  by  killing  off 
all  the  mosquitoes  in  Panama  when  the  canal  was  being 
built.  This  was  done  by  draining  out  the  places  where  they 
breed.  They  must  have  the  pools  of  stagnating  water  to 
breed  in.  Otherwise,  the  little  forms,  from  which  the  mosqui- 
toes develop,  die.  Draining  out  all  of  the  stagnating  pools  of 
water  prevents  malaria.  Another  thing  that  is  done  is  to 
flood  bodies  of  water  with  barrels  of  Panama  larvacide.  The 
latter  is  a  mixture  of  crude  oil,  caustic  soda,  carbolic  acid, 
and  resin.  It  kills  young,  developing  mosquitoes.  This 
work  of  mosquito  prevention  must  be  done  very  thoroughly, 
if  the  mosquitoes  are  to  be  exterminated.  A  tin  can  full  of 
stagnating  water  may  develop  thousands  of  mosquitoes. 
Another  remedy  is  to  put  small  trout  in  the  water  with  the 
hope  that  they  will  eat  up  the  larvae.  Still  another  thing  is 
to  have  bat  roosts  around  swampy,  stagnating  water.  It 
is  claimed  that  bats  keep  down  mosquitoes  by  feeding  on 
them. 

SUMMARY   OF   PRACTICAL   POINTS 

I.  Diagnosis.  Malaria. 

II.  Symptoms.  Chills    and    fever   every   third 

day. 

III.  Cause.  I.  Parasites  of  malaria  invad- 

ing blood  at  time  of  chill. 

2.  Parasites    of   malaria    mul- 
tiplying    in     cells     between 
chills. 

3.  Parasites    carried    by    mos- 
quitoes. 

IV.  Treatment.  Quinine. 


BOOK  SEVEN 
V.  Preventive  treatment.     Bass  treatment. 


VI.   Prevention. 


1.  Drainage. 

2.  Larvacide. 

3.  Bats. 

4.  Fish. 

5.  Quinine. 


i32          THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    22 

Mr.  J.  C.,  aged  twenty-two  years,  a  wharf  hand  at  New 
Orleans,  felt  very  sick  on  the  morning  of  July  4th.  His  head 
ached  terribly,  he  became  dizzy  and  pale,  and  was  so  weak 
that  he  could  not  hold  up  his  head.  Toward  evening  he  be- 
came drowsy  and  stupid  and  tossed  in  high  fever.  On  the 
fifth  and  sixth  he  continued  the  same  way.  On  the  seventh 
the  doctor  while  making  his  visit  discovered  that  there  were 
swellings  in  the  man's  groins.  His  feet,  which  had  been  bare 
all  summer,  were  considerably  flea-bitten.  On  the  night  of 
the  seventh  he  had  a  few  convulsions  and  died. 

What  do  you  think  is  the  matter  with  the  man? 


134          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    22 

At  autopsy  the  germs  of  bubonic  plague  were  found  in  the 
swollen  glands  in  the  man's  groin.  A  small-sized  epidemic  of 
bubonic  plague  occurred  about  this  time  in  New  Orleans. 
The  men  on  the  Board  of  Health  there  knew  that  the  disease 
was  spread  by  rats.  Fleas  carry  the  disease  from  rat  to  rat. 
When  the  rats  die,  the  fleas  start  biting  people  and  give  them 


The  plague  bacillus 

the  disease.     People  also  get  the  disease  from  the  waste  prod- 
ucts of  rats  which  get  into  food  and  on  the  fingers. 

The  health  authorities  isolated  all  suspicious  cases  and 
screened  them  off  so  that  no  fleas  could  get  to  them.  Then 
they  killed  off  all  of  the  plague-infected  rats  in  New  Orleans. 
A  small  army  of  men  was  hired.  Business  men  closed  their 
stores  and  allowed  their  employees  to  take  part  in  the  big 
rat  hunt.  As  rats  were  killed,  they  were  examined  to  see  if 
they  had  plague.  Many  did.  As  long  as  any  plague  rats 
were  found,  they  kept  up  the  hunt. 


BOOK  SEVEN  135 

Another  thing  that  was  done  to  prevent  the  disease  was 
to  provide  Haffkine's  preventive  treatment,  a  sort  of  vaccine 
which  is  used  to  prevent  the  disease.  Every  one  who  had 
been  exposed  was  allowed  to  have  the  treatment.  The 
epidemic  was  checked.  Only  twelve  cases  developed. 

In  India  and  China  where  these  things  are  not  done,  an 
epidemic  often  carries  off  a  fourth  or  fifth  of  the  population. 
The  disease  is  the  one  that  has  been  called  the  black  death. 
As  you  see,  modern  methods  of  sanitation  stopped  it  very 
promptly  at  New  Orleans.  Our  Health  Boards  wage  con- 
stant war  on  this  disease.  They  attempt  to  prevent  rats 
from  leaving  ships  and  coming  into  our  country.  Rats  carry 
several  other  diseases  about  which  we  shall  learn  later. 

People  should  not  allow  rats  and  mice  to  live  with  them. 
It  seems  impossible  to  exterminate  rats,  but  the  number 
could  be  kept  down  and  they  should  be  kept  out  of  houses. 
A  cat  will  usually  do  that.  Rat  poisons  around  a  house  are 
dangerous.  Children  sometimes  eat  them.  Dead  rats  also 
give  off  a  very  bad  odor. 

A  form  of  the  disease  called  the  pneumonic  form  because 
it  infects  the  lungs  sometimes  occurs.  This  is  very  deadly 
because  it  is  carried  in  the  air. 

SUMMARY    OF    PRACTICAL    POINTS 

I.  Diagnosis.  Plague. 

II.  Symptoms.  These  of  a  severe  infection. 

a.  Headache. 

b.  Dizziness. 

c.  Pallor. 

d.  Drowsiness. 

e.  Fever. 


136          THE  CASE-SYSTEM  OF  HYGIENE 

II.  Symptoms — cont.  f.    Swollen  glands  in  groins. 

g.  Germs  of  bubonic  plague 
in  glands. 

III.  Cause.  I.  Germs,  or  poisons  produced 

by  germs,  circulating  all  over 
body. 

2.  Germs  spread  by  fleas  and 
rats. 

IV.  Treatment.  Rest  in  bed. 

V.  Prevention.  i.  Kill  rats 

2.  Keep  out  rats  from  ships. 

3.  Haffkine's  treatment. 


138          THE  CASE-SYSTEM  OF  HYGIENE 


CASE   NO.   23 

Harold  W.,  aged  twenty-four  years,  came  to  the  hospital 
because  he  had  been  sick  for  three  days  with  a  headache, 
fever,  loss  of  appetite,  and  a  general  feeling  of  depression. 
The  trouble  had  started  suddenly,  three  days  before,  with  an 
attack  of  chills  and  vomiting.  When  he  was  examined,  it 
was  found  that  a  red  rash  had  come  out  on  his  body.  The 
rash  looked  a  little  like  the  rash  of  scarlet  fever  but  was 
more  spotted.  For  five  weeks  he  lay  in  bed  with  high  fever, 
and  part  of  the  time  with  delirium.  The  doctor  said  it  was  a 
case  of  typhoid  fever  but  the  blood  reaction  for  typhoid  fever 
was  never  positive. 

What  do  you  think  is  the  matter  with-the  man? 


140          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    23 

At  the  time  this  man  was  in  the  hospital,  all  of  the  doctors 
said  that  he  had  typhoid  fever.  At  the  time,  they  did  not 
know  very  much  about  typhus  fever.  It  was  a  very  rare 
condition.  When  the  war  had  been  going  on  a  little  while,  we 
began  to  hear  of  epidemics  of  typhus  fever  in  Servia.  Then 
all  the  doctors  got  down  their  books  and  looked  up  the 
symptoms  of  typhus  fever.  At  once  they  knew  that  this 
must  have  been  a  case  of  typhus  fever.  There  was  no  blood 
reaction  for  typhoid.  The  onset  was  sudden  with  a  chill 
and  vomiting.  The  onset  of  typhoid  is  very  gradual.  There 
is  no  rash  in  typhoid.  The  sudden  onset  and  rash  is  char- 
acteristic of  typhus. 

Another  thing  that  makes  one  feel  very  sure  that  this  was  a 
case  of  typhus  is  the  fact  that  the  man  was  so  dirty.  When 
he  came  in  he  was  very  lousy.  We  know  now  that  typhus 
fever  is  spread  by  lice.  The  reason  so  many  Servians 
got  the  disease  in  the  war  was  because  they  had  to  be 
so  dirty  and  were  so  lousy  in  the  trenches.  To  keep  down 
the  disease,  the  Russians  had  bath  trains  and  gave  their 
men  baths.  Wherever  they  were  able  to  keep  the  men  clean, 
the  disease  did  not  appear.  In  a  great  many  places,  where 
the  men  were  dirty  and  lousy,  the  disease  appeared  very 
promptly.  This  man  got  well  at  the  end  of  about  eight 
weeks. 

The  way  to  prevent  the  disease  is  to  isolate  cases  as  soon 
as  they  occur,  and  clean  them.  The  most  important  step 
in  preventing  the  disease  is  to  keep  clean.  That  means 
taking  a  bath  every  day  and  wearing  clean  clothes.  When- 
ever lice  appear  on  a  person's  clothing,  they  should  be  gotten 


BOOK  SEVEN  141 

rid  of  very  promptly.  Boiling  all  of  the  clothing,  under- 
clothing, and  towels,  will  kill  the  lice.  Changing  every 
day  and  again  boiling  the  clothes  will  kill  the  few  lice  that 
get  from  body  to  clothes  after  the  first  bath.  The  body 
should  be  bathed  each  day.  Kerosene  should  be  applied  to 
places  where  lice  might  be.  And  any  marks  where  the  lice 
have  been  should  be  smeared  with  sulphur  ointment. 
The  lice  may  be  removed  from  the  hair  by  cutting  it  off,  if  it 
is  a  boy  or  man,  and  administering  a  crude  oil  shampoo.  If 
it  is  a  girl,  a  series  of  crude  oil  shampoos  will  remove  the  lice 
from  the  hair. 

The  war  shows  trr  value  of  cleanliness.  Cases  of  diseases 
that  had  almost  disappeared — such  as  hospital  gangrene, 
gaseous  gangrene,  and  cholera — reappeared  by  the  thousand, 
amid  the  dirt  and  squalor  of  the  trenches.  In  clean  places 
these  diseases  are  not  found.  In  very  dirty  cities  and  coun- 
tries where  the  people  are  filthy  and  dirty,  they  are  always 
found  in  greater  or  less  numbers . 

SUMMARY   OF   PRACTICAL   POINTS 

I.  Diagnosis.  Typhus  fever. 

II.  Symptoms.  Those  of  a  severe  infection  plus 

a  red  rash. 

III.  Cause.  i.  Germs  of  typhus  fever  at- 

tacking man. 
2.  Germs  carried  by  lice. 

IV.  Treatment.  Rest  in  bed. 

V.  Prevention.  I.  Cleanliness. 

2.  Isolation. 


i42          THE  CASE-SYSTEM  OF  HYGIENE 


SUMMARY   NO.    3 

The  last  three  cases  have  been  about  diseases  that  people 
get  from  animals.  The  first  case  was  about  malaria,  which 
people  get  from  mosquitoes.  The  second  case,  about  plague, 
which  people  get  from  fleas,  and  the  third  case  about  typhus 
fever,  which  people  get  from  lice.  We  also  noted  that  rats 
were  a  factor  in  spreading  plague.  These  are  not  all  of  the 
diseases  that  animals  convey  to  people. 

From  the  first  case,  that  of  the  little  boy  who  had  malaria, 
we  may  learn  several  general  lessons. 

1.  Malaria  is  caused  by  parasites  which  get  into  people 
when  a  certain  kind  of  mosquito  bites  them. 

2.  The  mosquito  which  carries  the  parasite  of  malaria  has 
spots  on  its  wings. 

3.  Once  the  parasites  of  malaria  get  inside  of  a  person, 
they  multiply  in  the  blood  and  cause  chills  and  fever  and 
headache  and  destroy  the  blood  so  that  a  person  looks  pale. 

4.  Quinine  cures  malaria. 

5.  After  an  attack  of  chills  and  fever,  it  is  necessary  to 
take  quinine  once  a  week  at  just  the  right  time  to  kill  ofF  the 
form  of  the  parasite  that  remains  in  the  blood. 

6.  Malaria  can  be  prevented  by  killing  off  mosquitoes. 

7.  This  may  be  done  by  draining,  the  use  of  Panama  larva- 
cide,  putting  trout  in  stagnating  water,  and  erecting  bat  roosts. 

8.  Bass  of  New  Orleans  deserves  great  credit  for  his  work 
on  malaria. 

From  the  second  case,  that  of  the  man  who  had  plague  at 
New  Orleans,  we  may  learn  several  general  lessons. 


BOOK  SEVEN  143 

1.  People  get  plague  from  the  bites  of  fleas  and  from  the 
discharges  of  rats  which  sometimes  contaminate  food. 

2.  Fleas  spread  the  disease  from  rat  to  rat  and  to  people 
when  the  rats  die  out. 

3 .  The  disease  can  be  prevented  by  killing  off  all  rats  who 
have  plague  and  by  keeping  rats  with  plague  out  of  this 
country. 

4.  Rats  keep  coming  to  this  country  from  China  and  India 
and  other  countries  where  they  have  plague. 

5.  If  an  epidemic  does  break  out,  all  suspicious  cases  should 
be  isolated  and  screened  ofF. 

6.  In  case  of  an  epidemic,  all  of  the  people  who  have  been 
exposed  should  be  given  the  vaccine  for  plague. 

7.  People  should   keep   rats   and   mice  from   living  with 
them  by  providing  rat-proof  cellars  and  cats. 

8.  A  form  of  plague  called  the  pneumonic  form,  because  it 
infects  the  lungs,  sometimes  occurs.     This  is  extremely  con- 
tagious and  deadly  because  it  is  carried  in  the  air. 

From  the  third  case,  that  of  the  man  who  had  typhus 
fever  which  was  not  recognized  by  any  of  the  doctors,  we 
may  learn  several  general  lessons. 

1.  Typhus  fever  is  spread  by  lice. 

2.  Countries  which  are  lousy  and  dirty  have  such  diseases 
as  typhus  fever  all  of  the  time. 

3.  During  the  war,  when  people  had  to  be  lousy  and  dirty 
in  the  trenches,  epidemics  of  typhus  fever  occurred. 

4.  Typhus  fever  may  be  prevented  by  keeping  one's  self 
and  one's  house  and  one's  premises  and  one's  town  and  one's 
country  clean. 


146          THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    24 

Albert  L.,  who  was  employed  as  a  milker  in  a  dairy,  no- 
ticed that  several  of  the  cows  seemed  sick.  Their  mouths 
dripped  saliva.  Several  of  them  had  little  eruptions  between 
their  toes  and  above  their  hoofs.  Some  of  the  patches 
were  beginning  to  be  running  sores.  More  cows  became 
sick.  About  a  week  after  he  noticed  the  first  sick  cow  Albert 
L.  awakened  and  felt  some  sore  spots  in  his  mouth.  For  a 
few  days  he  had  a  rather  sore  mouth.  On  the  third  day  a 
few  little  pimples,  full  of  serum,  broke  out  on  his  hands.  He 
felt  out-of-sorts  for  five  or  six  days.  Then  the  pimples  dis- 
appeared and  he  recovered. 

What  do  you  think  is  the  matter  with  the  man? 


148          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    24 

The  foot  and  mouth  trouble  with  the  cows  indicates  foot 
and  mouth  disease.  You  will  notice  the  man  had  almost 
the  same  trouble  that  the  cows  had.  He. had  trouble  with 
his  mouth  and  with  his  hands.  The  same  germs  were  at- 
tacking the  man  that  were  attacking  the  cows.  This  disease 
is  called  foot  and  mouth  disease. 

The  disease  is  spread  by  germs  from  the  saliva  and  from 
the  sores.  You  can  easily  see  how  every  cow  in  the  herd 
would  be  exposed  and  how  all  the  milkers  attending  the 
cows  would  be  exposed.  The  disease  does  not  kill  people. 
It  is  usually  very  mild.  It  kills  some  cows,  but  the  great 
damage  it  does  is  to  affect  them  so  that  they  are  not  any 
good  for  milk  or  beef  for  at  least  one  year.  That  results  in 
the  loss  of  millions  of  dollars,  if  the  disease  is  present  in 
many  parts  of  the  country.  There  is  no  treatment  for  the 
disease  that  is  of  any  account.  Once  it  gets  started,  it  must 
run  its  course. 

People  can  keep  from  getting  the  disease  from  animals  by 
keeping  their  hands  clean  when  they  are  around  them  and 
by  pasteurizing  any  questionable  milk.  Cattle  with  the 
disease  should  be  destroyed  very  promptly.  Herds  with  the 
disease  should  be  quarantined  so  that  the  animals  cannot 
carry  it  to  another  herd.  During  and  after  quarantine 
dairy  barns  and  racks  should  be  disinfected  by  a  careful 
scrubbing  with  soap,  chloride  of  lime,  and  water. 

The  marine  hospital  service  wages  a  constant  warfare 
against  this  disease.  They  attempt  to  inspect  all  of  the 
cattle  that  come  into  the  United  States  and  in  that  way  to 
keep  the  disease  out.  When  you  get  to  be  a  citizen  you 


BOOK  SEVEN  149 

should  see  to  it  that  there  is  a  national  Board  of  Health  and 
that  such  activities  as  this  are  not  handicapped  for  lack  of 
funds.  Although  it  had  been  handicapped  for  lack  of  funds 
for  a  great  many  years,  our  marine  hospital  service  kept  the 
foot  and  mouth  disease  out  of  the  United  States  while  it  was 
raging  in  Europe.  In  addition  to  keeping  out  this  disease, 
it  has  done  a  great  deal  to  keep  out  cholera,  yellow  fever, 
plague,  typhus  fever,  smallpox,  and  leprosy.  Seldom  do  you 
hear  of  these  diseases  in  this  country.  Other  countries  are 
constantly  sending  such  cases  to  our  ports  but  they  do  not 
get  in. 

SUMMARY   OF   PRACTICAL   POINTS 

I.  Diagnosis.  Foot  and  mouth  disease 

II.  Symptoms.  I.  History  of  cows  with   foot 

and  mouth  disease. 

2.  Sores  in  mouth. 

3.  Sores  on  hands. 

4.  Out-of-sorts. 

III.  Cause.  I.  Germs    of   disease    causing 

sores. 

2.  Germs  spread  in  discharge 
from  cows'  mouth  and  feet. 

IV.  Treatment.  Rest. 

V.  Prevention.  I.  Destroy   animals   with   the 

disease. 

2.  Quarantine  herds  with  it. 

3.  Disinfect     carefully    places 
where  it  has  been. 

4.  Cattle  inspection  at  ports. 


1 50         THE  CASE-SYSTEM  OF  HYGIENE 


CASE   NO.    25 

Mrs.  R.  D.,  aged  twenty-five  years,  was  seized  suddenly 
with  a  chill  on  February  2d.  She  felt  very  feverish  after- 
ward; had  a  splitting  headache;  and  had  severe  pains  in  the 
back.  Just  before  the  chill  she  felt  sick  and  vomited. 

On  February  jd,  there  was  a  reddish  eruption  on  her  chest 
that  looked  like  measles.  On  the  fourth,  it  had  faded  and  small 
round  spots  began  to  come  on  her  chest.  They  were  a 
brownish  color  and  about  the  size  of  a  French  pea. 

What  do  you  think  is  the  matter  with  the  woman? 


152 


THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    2$ 

Here  is  another  disease  which  causes  eruptions  on  the  skin. 
Smallpox  is  such  a  disease.  An  old  doctor  who  had  seen  a 
good  many  cases  of  smallpox  recognized  the  condition  at  once. 

Whether  a  germ  causes  smallpox  we  do  not  know.  We 
know,  that  the  disease  is  spread  from  the  sores  in  the  skin  and 


A  case  of  smallpox  resembling  measles, 
third  day  of  eruption 

After  Welsh  fef  Schamberg.    Courtesy,  Lea  fc?  Febiger 

from  the  discharges  of  the  nose  and  throat.  Smallpox  is  looked 
upon  as  a  serious  disease.  It  is  bad  enough  but  never  did  re- 
sult in  as  many  deaths  as  either  measles  or  whooping  cough. 
Once  a  person  has  acquired  the  disease,  a  great  deal  can  be 
done  for  him  by  careful  nursing.  A  good  nurse  can  keep  the 


BOOK  SEVEN  153 

sores  clean  and  keep  the  sick  person  comfortable.  Most  of 
the  deaths  which  occur  in  smallpox  occur  because  the  sores 
are  allowed  to  become  infected  with  pus  germs. 

As  you  probably  know,  vaccination  prevents  smallpox. 
Before  Jenner  discovered  that  smallpox  could  be  prevented 
by  vaccination,  there  was  a  great  deal  of  it  in  this  country. 
It  was  more  common  than  measles.  Since  its  compulsory 


Smallpox  in  an  unvaccinated  boy, 
eighth  day  of  eruption 

After  Schambtrg.     Courtesy,  Lea  y  Febiger 

use,  you  seldom  hear  of  a  case.  Before  the  United  States 
occupied  the  Philippine  Islands,  there  was  no  vaccination 
and  there  was  a  great  deal  of  smallpox.  After  the  United 
States  occupied  the  Philippine  Islands,  they  compelled  all 
of  the  natives  to  be  vaccinated.  Cases  of  smallpox  are  now 


i54          THE  CASE-SYSTEM  OF  HYGIENE 

very  rare  in  the  Philippine  Islands.  It  seems  a  shame  that 
there  cannot  be  a  vaccine  which  will  prevent  every  disease 
that  is  caused  by  germs.  There  are  preventive  vaccines 
for  typhoid  fever,  tetanus  and  scarlet  fever,  cholera  and 
plague. 

You  will  sometimes  hear  people  say  that  vaccination  is 
harmful,  that  some  people  have  been  killed  by  it.     No  per- 


This  vaccination  shield  keeps  dirt  out 
and  lets  air  in 

son  has  ever  been  killed  by  the  vaccine  itself.  It  has  hap- 
pened that  the  wound  made  when  putting  the  vaccine  in  has 
become  infected  with  other  germs.  The  germs  of  tetanus 
have  been  in  the  skin  when  the  person  was  being  vacci- 
nated against  smallpox.  Later  the  person  developed  lock- 
jaw and  died.  Such  things  can  be  avoided  by  cleaning 
the  skin  before  the  vaccination  is  made,  by  taking  precautions 
to  have  the  vaccine  pure,  by  taking  precautions  to  keep  dirt 
out  of  the  wound  after  vaccination,  and  at  the  same  time 


BOOK  SEVEN  155 

leaving  the  wound  open  to  the  air.  If  the  wound  is  left 
open  to  the  air,  tetanus  germs  will  not  grow  in  it.  A  vacci- 
nation shield  such  as  the  one  illustrated  does  this.  The  dan- 
ger of  tetanus  from  the  modern  vaccine  is  practically  nothing. 
It  has  never  been  proved  that  the  vaccine  itself  contained 
the  germs  of  tetanus.  In  the  very  small  number  of  cases 
of  tetanus  that  have  occurred  the  germs  in  all  probability  were 
in  the  skin  before  the  vaccine  was  administered. 

SUMMARY   OF    PRACTICAL    POINTS 

I.  Diagnosis.  Smallpox. 

II.  Symptoms.  A.  In  early  stage. 

1.  Those  of  an  infection  by 
germs. 

2.  There  may  be  a  rash. 
B.  Later. 

I.  Spots  come  out. 

III.  Cause.  I.  Probably  a  germ. 

2.  Spread    from   nose,    throat, 
and  sores  on  skin. 

IV.  Treatment.  i.  Rest  in  bed. 

2.  Cleanliness. 

V.  Prevention.  Vaccination. 


iS6          THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    26 

Martin  A.,  aged  twenty-two  years,  was  employed  in  a 
hospital  to  sort  clothes  that  came  from  patients  and  from  the 
operating  room.  September  2d,  his  right  little  finger  was 
scratched  on  a  pin.  That  night  it  pained  a  little.  On  the 
third,  it  was  slightly  reddened  and  still  pained  enough  to  bother 
him.  On  the  fourth,  the  pain  was  worse  and  kept  him  awake 
that  night.  He  could  not  move  the  finger.  The  finger  was 
red,  hot,  and  more  swollen.  On  the  fifth,  the  pain  had  ex- 
tended to  the  thumb.  The  little  finger  was  swollen  to  about 
twice  normal  size.  It  was  hot  and  of  a  red,  angry  color. 
A  doctor  was  consulted.  He  advised  that  the  little  finger  be 
incised.  The  man  refused  to  "have  any  cutting  done,"  as  he 
expressed  it. 

What  do  you  think  is  the  matter  with  the  man? 


i58          THE  CASE-SYSTEM  OF  HYGIENE 

DISCUSSION — CASE  NO.   26 

You  would  expect  that  the  clothes  from  a  hospital  would 
be  teeming  with  all  sorts  of  germs.  They  were  and  the  man 
had  undoubtedly  gotten  some  of  them  into  the  scratch  on  his 
little  finger.  The  germs  had  attacked  the  little  finger  and 
had  caused  it  to  swell  up  and  become  red  and  painful.  You 
have  learned  in  a  previous  case  that  the  little  finger  is  con- 
nected with  the  thumb  by  its  tendon  sheath,  and  the  germs 
are  apt  to  extend  from  the  little  finger  to  the  thumb. 


The  tendon  sheathes  of  the  thumb  and  little 
finger  communicate  in  the  palm 

The  man  was  very  foolish  not  to  have  an  incision  made  in 
the  little  finger  so  that  the  germs  could  drain  out.  The 
hand  should  have  been  put  up  in  a  warm,  wet,  antiseptic 
dressing.  That  might  have  stopped  the  infection.  The 
man  insisted  on  letting  the  thing  go  on  five  days  with  almost 
no  treatment.  At  the  end  of  that  time  his  entire  arm  was 
infected  and  he  had  to  have  an  operation  at  which  he  was 
given  ether  and  the  entire  arm  and  hand  had  about  a  dozen 
slashes  made  in  them.  Eight  drains  were  put  in.  For  a 
time  the  man's  life  was  despaired  of  but  he  did  pull  through. 

At  the  end  of  two  months  the  arm  and  hand  were  healed 
up  with  a  great  many  scars  on  them. 


BOOK  SEVEN  159 

The  man  had  been  warned  that  he  was  doing  dangerous 
work;  had  been  told  that  he  must  wear  rubber  gloves;  that 
he  must  keep  his  hands  clean;  and  that,  if  he  did  get  any  small 
wounds  in  his  hands,  he  should  have  them  treated  immedi- 
ately. He  did  none  of  these  things.  You  see  the  conse- 
quences. 

A  great  many  people  in  hospitals,  laundries,  and  homes 
handle  clothes  that  come  from  other  people.  They  should 
remember  that  these  articles  are  dangerous  and  they  should 
wear  rubber  gloves  while  handling  them.  They  should  be 
careful  to  keep  the  rubber  gloves  clean  and  to  keep  their 
hands  clean  and,  if  they  do  get  any  small  wounds,  they  should 
treat  them  immediately. 

SUMMARY    OF    PRACTICAL    POINTS 

I.  Diagnosis.  Infection  of  hand. 

II.  Symptoms.  Swelling,  heat,  redness,  pain. 

III.  Cause.  I.  Germs  had  entered  scratch. 

2.  Germs  attacking  hand. 

IV.  Treatment.  Incision  and  drainage. 

V.  Prevention.  I.  Proper  care  of  wounds. 

2.  Care     in     handling     dirty 
clothes. 

3.  Rubber  gloves. 


160          THE  CASE-SYSTEM  OF  HYGIENE 


'CASE    NO.    27 

Mrs.  E.  R.,  aged  thirty  years,  was  careful  of  her  hands  in 
doing  housework.  She  always  wore  rubber  gloves  while 
washing  dishes  or  clothes.  On  July  yth  she  scratched  her 
little  finger  on  a  pin.  She  put  peroxide  on  it  and  let  it  go. 
On  July  8th,  the  finger  throbbed,  was  a  bit  reddened  and 
hot.  On  the  ninth,  it  was  swollen  markedly. 

What  do  you  think  is  the  matter  with  the  woman? 


162          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    27 

This  is  another  case  of  sepsis.  This  woman,  however, 
did  not  neglect  the  infection.  She  went  immediately  to  a 
doctor  who  put  a  hot,  wet,  antiseptic  dressing  on  the  finger 
and  avoided  operation.  She  was  well  in  four  days. 

The  doctor  asked  her  why  she  did  not  wear  rubber  gloves 
when  washing  clothes  or  dishes.  She  replied  that  she  did. 
He  discovered  the  trouble  was  that  she  did  not  always  wash 
the  gloves  carefully  after  she  was  through  using  them.  If  a 
person  is  going  to  use  rubber  gloves  that  must  be  done. 
Otherwise,  the  gloves  will  grind  germs  into  the  skin  as  the 
hands  are  used. 

SUMMARY   OF   PRACTICAL    POINTS 

I.  Diagnosis.  Infection  of  finger. 

II.  Symptoms.  Heat,  redness,  swelling,  pain, 

III.  Cause.  I.  Germs  from  scratch  attack- 

ing finger. 

2.  Germs  came  from  dirty  rub- 
ber gloves. 

IV.  Treatment.  Antiseptic  bath. 

V.  Preventive  treatment.     Early  treatment  of  infections. 
VI.  Prevention.  Cleanliness. 


164          THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    28 

Harold  L.,  aged  sixteen  years,  while  crossing  the  street 
was  compelled  to  dodge  a  fast-flying  motorcycle.  Neither 
he  nor  the  driver  were  knocked  down  but  the  machine  ran 
over  the  toes  of  his  left  foot  and  took  most  of  the  skin  off  the 
top  of  the  fourth  and  little  toes.  He  cleaned  the  toes  up 
with  peroxide  and  bound  them  up  with  some  clean  white 
rags.  After  that  he  went  on  playing  baseball,  going  in 
bathing,  and  dancing  just  as  usual.  Most  of  the  time  there 
was  no  bandage  over  the  toes. 

What  danger  was  the  young  man  in? 


1 66          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    28 

The  young  man  was  in  danger  of  having  his  toes  infected 
with  germs.  He  was  exposing  the  wound  to  germs  by  not 
keeping  them  covered  up  and  was  constantly  weakening  the 
tissues  of  the  toes  by  bruising  them  as  he  walked.  The  bruised 
and  weakened  tissues  were  not  able  to  fight  off  the  germs  as 
well  as  healthy  tissues. 

The  result  was  that  the  young  man  did  get  an  infection  of 
the  toes.  It  ended  by  his  getting  an  abscess  back  of  the  knee 
which  required  an  operation  and  laid  him  up  for  a  month. 

He  should  have  cleaned  the  wounds  up  carefully  immedi- 
ately or  painted  them  with  tincture  of  iodine  and  put  on  a 
sterile  dressing.  Then  he  should  have  kept  off  the  foot  until 
the  toes  had  at  least  partly  healed  up. 

A  great  many  motorcycle  and  automobile  accidents  occur 
because  people  cross  the  street  between  crossings.  Most  of 
these  can  be  prevented  by  a  law  forbidding  people  to  cross 
the  street  between  crossings.  In  a  crowded  city  district 
elevated  street  crossings  or  subway  street  crossings,  at  cor- 
ners, would  prevent  a  great  many  automobile  accidents. 

Many  accidents  occur  in  cities  because  people  attempt  to 
cross  before  the  officer  signals.  Wait  for  him.  Do  not  try 
to  cut  through  automobiles. 

SUMMARY   OF    PRACTICAL    POINTS 

I.  Diagnosis.  Danger  of  infection. 

II.  Symptoms.  I.  Bruising  wounded  tissues. 

2.  Not  keeping  germs  out. 

III.  Cause.  I.  Tissues  were  weakened. 


BOOK  SEVEN 


167 


III.  Cause— Cont. 


IV.  Treatment. 


2.  Germs    attacked    tissues — 

They  caused  infection  of  toes 

and  an  abscess  back  of  knee. 

Operation. 

V.  Preventive  treatment.     Care  of  small  wounds. 

1.  Peroxide    or    tincture    of 
iodine. 

2.  Sterile  dressing  and  band- 
age. 

3.  Rest  of  part. 

Prevent  motor  accidents. 

1.  By  not  crossing  streets  be- 
tween crossings. 

2.  By   having   depressed   or 
elevated    street    intersec- 
tions. 


VI.  Prevention. 


i68          THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    29 

John  D.,  aged  nineteen  years,  an  employee  in  a  mince-pie 
factory,  had  his  hand  cut  in  four  places  by  a  mince-meat 
slicer.  They  were  not  very  large  cuts  and  did  not  bleed  very 
much.  So,  he  merely  bound  them  up  with  his  handkerchief 
and  some  tobacco  which  had  been  chewed  up.  The  hand 
was  so  cumbersome  that  he  could  not  work.  So,  he  retired 
to  a  baseball  game.  On  the  third  day  the  hand  began  to 
throb  and  pain.  A  friend  told  him  that  it  was  just  the  cuts 
healing.  The  next  day  the  forearm  throbbed  and  ached. 
At  night  the  whole  arm  pained  and  the  forearm  was  red.  hot, 
and  swollen. 

What  do  you  think  is  the  matter  with  the  man  ? 


170          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    2Q 

Here  is  still  another  case  of  sepsis,  the  same  old  story 
a  small  wound  neglected — germs  got  into  it — in  a  few  days 
the  whole  hand  and  arm  were  inflamed — operation — slashes 
by  the  doctor — six  weeks  getting  well.  It  pays  to  take  care 
of  a  small  wound  properly  at  the  start.  Putting  a  chew  of 
tobacco  on  the  wound  is  almost  as  bad  as  spitting  on  it. 
Of  course,  a  great  many  germs  from  the  mouth  were  put  into 
the  wound. 

A  great  many  accidents  occur  in  factories,  shops,  and  other 
industrial  institutions  which  ought  to  be  prevented.  Every 
factory  has  to  work  out  this  problem  of  prevention  for  itself. 
Workmen  should  not  be  exposed  to  dangerous  machinery. 
Most  states  require  that  steam  boilers  be  inspected  to  see 
whether  they  are  safe  or  not.  There  is  no  reason  why  all 
machinery  should  not  be  inspected.  Boiler  inspections  not 
only  prevent  boiler  explosions  and  save  lives  but  actually  pay 
the  manufacturers.  They  keep  the  machinery  in  better  shape. 
It  works  better  and  lasts  longer  as  a  result  of  the  inspection. 
If  it  did  not  pay,  you  must  remember  that  the  workers  are 
human  beings  and  that  human  beings  have  a  right  to  their 
lives.  If  precautions  can  be  taken  to  save  their  lives,  these 
precautions  should  be  taken. 


SUMMARY    OF    PRACTICAL    POINTS 

I.  Diagnosis.  Infection  of  arm. 

II.  Symptoms.  Heat,    redness,    swelling,    and 

pain. 


III.  Cause. 

IV.  Treatment. 

V.  Preventive  treatment. 
VI.  Prevention. 


BOOK  SEVEN  171 

Germs,  probably  from  mouth. 
Incisions  and  drains. 
Proper  care  of  wounds. 

1.  Safe  machinery. 

2.  Factory  inspection. 


172          THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    30 

Andrew  C.,  aged  sixteen,  ran  a  thorn  of  a  palm  tree 
through  his  sock  and  shoe  into  his  foot  for  about  an  inch.  He 
pulled  the  thorn  out  and  thought  nothing  of  it.  Next  day 
the  foot  began  to  ache  and  throb. 

What  should  you  look  out  for  and  try  to  prevent  in  this  case  ? 


i74          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    30 

Here  is  still  another  case  of  sepsis.  In  this  case  there  are 
two  things  to  watch  out  for.  One  of  them  is  tetanus.  As 
you  have  learned  before,  tetanus  may  develop  in  any  deep 
wound  which  is  not  exposed  to  the  air.  Consequently, 
the  serum  should  be  given.  The  second  danger  is  the  danger 
of  a  foreign  body.  A  piece  of  sock  or  something  of  the  kind 
may  have  been  stuck  into  the  wound.  The  doctor  who  at- 
tended the  case  thought  of  both  of  these  things.  He  gave 
the  serum  and  he  opened  up  the  wound.  In  the  bottom  of 
the  wound  he  found  a  piece  of  sock.  He  put  a  large,  an- 
tiseptic dressing  on  the  wound.  It  was  all  healed  up  in  a 
week.  If  he  had  failed  to  find  the  piece  of  sock,  the  wound 
would  probably  have  become  infected  and  another  bad  case 
of  sepsis  would  have  occurred.  In  case  of  a  punctured  wound 
like  this,  always  remember  the  danger  of  a  foreign  body. 

SUMMARY    OF    PRACTICAL    POINTS 

I.  Diagnosis.  Infection  of  foot. 

II.  Symptoms.  Pain. 

III.  Cause.  i.  Germs  attacking  foot. 

IV.  Treatment.  I.  Opening  wound. 

2.  Rest. 

3.  Antiseptic  dressing. 

V.  Preventive  treatment.    Tetanus  serum. 


176          THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    31 

Clara  L.,  aged  eight  years,  began  to  have  aching  eyelids 
about  February  ist.  During  the  next  seven  days  her  eyes 
were  painful,  discharged  rather  freely,  and  the  lids  were 
stuck  together  frequently.  During  this  time,  it  was  almost 
impossible  for  her  to  see  out  of  the  eyes.  By  February  8th, 
she  was  better  but  for  the  next  month  had  sore  eyes.  Then 
she  became  unable  to  see  out  of  her  right  eye. 

What  do  you  think  is  the  matter  with  the  little  girl? 


THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    31 

The  little  girl  evidently  has  something  the  matter  with  her 
eyelids  and  her  eyes.  A  doctor  who  knows  how  the  disease 
trachoma  acts  would  immediately  suspect  this  disease  which 
first  affects  the  eyelids  and  later  affects  the  eyeballs.  A 
doctor  did  find  trachoma  bodies  on  the  lid  and  he  found  that 
the  things  which  cause  trachoma  had  also  attacked  the 
cornea  of  the  right  eye  and  made  it  opaque. 


KiftlfeV 


Trachoma  bodies 

No  one  knows  what  the  things  that  cause  trachoma  are, 
whether  they  are  germs  or  not.  They  act  like  germs  but  no 
one  has  ever  seen  them.  The  disease  is  spread  from  eye  to 
eye  by  means  of  fingers.  Once  the  disease  has  started,  it  is 
very  hard  to  cure.  The  lids  have  to  be  scraped  and  chem- 
icals applied  to  them.  Usually  a  case  lasts  for  years,  and 


BOOK  SEVEN  179 

often  as  in  this  case  results  in  an  injury  to  the  eyesight.  Of 
course,  this  little  girl  ought  to  have  been  taken  to  a  doctor 
when  the  trouble  began.  It  would  have  been  easier  to 
cure  it  then  than  at  a  later  time.  If  you  ever  have  any 
eye  trouble  that  lasts  longer  than  two  or  three  days,  do  not 
delay  about  seeing  a  doctor.  If  pus  ever  runs  from  your  eyes 
see  a  doctor  at  once. 

Health  authorities  take  several  measures  to  prevent  the 
disease.  In  some  cities  a  person  with  the  disease  has  to 
wear  spectacles  of  an  odd  green  shade  so  that  other  people 
may  avoid  him.  It  is  very  hard  to  isolate  cases  of  the  dis- 
ease which  last  so  long.  Every  immigrant  who  comes  into 
this  country  has  his  eyes  examined.  If  he  has  trachoma,  he 
has  to  go  back.  The  disease  is  spread  by  common  drinking 
cups,  towels,  and  washbowls.  Common  drinking  cups  and 
towels  have  been  pretty  well  abolished.  If  you  have  to  use  a 
public  washbowl,  always  wash  it  out  carefully  before  using  it. 

Trachoma  is  a  very  common  disease  in  European  countries 
where  it  causes  a  great  deal  of  blindness.  We  are  just  be- 
ginning to  get  the  disease  in  our  large  cities  where  immigrants 
from  European  countries  come.  Now  is  a  good  time  to  stamp 
the  disease  out.  The  only  way  that  can  be"done  is  by  isolat- 
ing all  cases  of  trachoma  until  they  are  cured. 

SUMMARY    OF    PRACTICAL    POINTS 

I.  Diagnosis.  Trachoma. 

II.  Symptoms.  Early  stage. 

1.  Pain  in  eyes. 

2.  Discharge  from  eyes. 

3.  Difficulty  in  seeing. 
Later  stage. 


i8o          THE  CASE-SYSTEM  OF  HYGIENE 

II.  Symptoms — cont.  I.  Inability  to  see. 

2.  Trachoma  bodies. 

III.  Cause.  I.  Germs    probably    attacking 

eyes. 
2.  Germs  make  cornea  opaque. 

IV.  Treatment.  i.  See  a  doctor. 

V.  Prevention.  I.  Isolate  cases. 

2.  Keep  cases  out  of  the  coun- 
try. 

3.  Green  glasses. 

4.  Abolish  common  towels  and 
drinking  cups. 


i82          THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    32 

Baby  K.,  aged  five  days,  began  to  have  running  eyes  on 
September  yth.-  On  the  morning  of  the  eighth,  they  were  dis- 
charging pus  freely. 

What  do  you  think  is  the  matter  with  the  baby? 


i84          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    32 

It  often  happens  that  babies  get  inflammations  of  the  eyes. 
Such  an  inflammation  is  called  ophthalmia,  which  in  Greek 
means  the  inflammation  of  an  eye.  These  inflammations 
are  caused  by  different  sorts  of  germs.  Sometimes  they  are 
so  bad  that  the  eyesight  is  completely  destroyed  and  the 
baby  goes  blind. 


An  inflammation  of  the  eye,  ophthalmia 

This  baby  had  a  very  bad  infection.  By  the  evening  of 
the  eighth,  the  eyes  were  swollen  shut  so  that  the  lids  had 
to  be  pried  apart  to  see  the  eyeballs.  Both  corneas  were 
opaque.  The  baby  was  removed  to  the  eye  and  ear  hos- 
pital but  in  spite  of  all  that  could  be  done  both  eyes  be- 
came blind. 


BOOK  SEVEN  185 

This  should  have  been  prevented.  Every  baby  should 
have  a  few  drops  of  a  weak  solution  of  silver  nitrate  put  into 
his  eyes  when  he  is  one  day  old.  Many  cities  require  by  law 
that  this  be  done  and  they  require  that  every  case  of  eye 
infection  in  a  baby  be  reported  to  the  Board  of  Health. 
These  two  measures  prevent  a  great  many  cases  of  the  dis- 
ease. Only  a  doctor  should  use  the  nitrate  of  silver. 
Otherwise  harm  may  be  done. 

Usually  prompt  treatment  will  save  one  or  both  eyes. 
If  one  eye  only  is  infected,  the  other  eye  can  be  packed  off 
with  aristol  powder  and  a  pad  of  chamois  skin  so  that  no 
germs  get  in  from  the  infected  eye.  The  treatment  for  the 
condition  often  clears  it  up  before  the  cornea  is  infected  so 
that  a  perfect  recovery  results. 

SUMMARY    OF    PRACTICAL    POINTS 

I.  Diagnosis.  Inflammation  of  eyes. 

II.  Symptoms.  Discharge  of  pus. 

III.  Cause.  Germs  attacking  eyes. 

IV.  Treatment.  See  doctor. 

V.  Preventive  treatment.     Early  diagnosis  and  treatment. 
VI.  Prevention.  Drops  in  eyes  of  baby. 

SUMMARY  NO.  4 

The  last  eight  cases  have  all  been  about  diseases  that  were 
spread  from  the  surface  of  the  body.  We  have  considered 
foot  and  mouth  disease,  sepsis,  trachoma,  and  ophthalmia. 
We  have  learned  that  the  ge/ms  of  these  diseases  occur  in 


1 86          THE  CASE-SYSTEM  OF  HYGIENE 

the  sores  which  appear  on  the  surface  or  the  discharges  which 
appear  on  the  surface.  These  germs  are  spread  by  means  of 
fingers.  The  germs  get  from  the  fingers  to  various  objects. 
Then  these  objects  are  handled  by  the  fingers  of  the  second 
person  and  the  germs  get  from  the  fingers  of  the  second  per- 
son to  that  person's  body.  Different  measures  must  be 
adopted  to  prevent  different  diseases. 

The  first  case  was  about  the  young  man  who  had  foot  and 
mouth  disease.  Foot  and  mouth  disease  very  seldom  attacks 
a  person.  When  it  does  it  is  very  mild.  It  causes  a  great 
deal  of  damage  to  cattle,  killing  off  many  and  affecting  many 
more  so  that  they  are  of  no  account  for  a  year  or  two. 
When  foot  and  mouth  disease  appears  in  cattle,  herds  with  it 
should  be  quarantined  and  cattle  with  it  should  be  de- 
stroyed. For  many  years  our  marine  hospital  service  has 
kept  the  disease  out  of  the  country,  although  it  was  raging  in 
Europe.  When  you  get  to  be  a  citizen,  see  to  it  that  the 
marine  hospital  service  has  a  good  chance  to  do  its  work. 
It  is  a  very  good  thing.  It  would  be  more  effective,  if  there 
were  a  National  Board  of  Health. 

The  second,  third,  fourth,  fifth,  and  sixth  cases  were  all 
cases  of  sepsis.  The  first  case  was  about  the  man  who  was 
careless  with  dirty  clothes  in  a  hospital.  His  carelessness 
caused  a  very  bad  infection  which  almost  resulted  in  death, 
and  did  result  in  crippling  one  arm  and  hand  considerably. 
Many  cases  of  sepsis  can  be  avoided  by  wearing  rubber 
gloves,  keeping  the  hands  clean,  and  treating  ajiy  small  cut 
or  wound  as  soon  as  it  is  acquired.  The  proper  treatment 
for  a  small  cut  or  wound  is  to  wash  it  out  with  peroxide  or 
paint  it  with  tincture  of  iodine  and  then  put  on  a  sterile 
dressing.  Any  person  who  is  handling  clothing  from  other 
persons  should  wear  rubber  gloves. 


BOOK  SEVEN  187 

The  second  case  was  about  the  woman  who  did  wear 
rubber  gloves  but  did  not  keep  them  clean.  She  was  wise 
enough  to  go  to  a  doctor  when  the  infection  started  and  an 
antiseptic  dressing  would  cure  it.  Keeping  the  rubber  gloves 
washed  prevented  further  infection. 

The  third  case  was  about  a  young  man  who  kept  on  bruis- 
ing his  toes  after  he  had  been  wounded  in  a  motorcycle  acci- 
dent. The  bruised  tissues  were  weakened  and  an  infection  re- 
sulted. After  a  wound,  it  is  necessary  to  keep  the  tissues  from 
being  weakened  by  use.  Many  motorcycle  and  automobile 
accidents  can  be  prevented  by  a  law  forbidding  people  to 
cross  the  street  between  crossings  OF  before  signal.  Depressed 
or  elevated  street  intersections  will  also  prevent  accidents. 

The  next  case  of  sepsis  was  about  the  young  man  who 
worked  in  the  mince-pie  factory.  He  had  his  hand  cut  and 
treated  it  by  putting  on  a  chew  of  tobacco.  The  result  was 
the  usual  infection,  operation,  and  stay  in  the  hospital  for 
several  weeks.  From  this  case  you  may  see  how  important 
it  is  to  treat  wounds  properly  in  the  first  place.  A  great 
many  factory  accidents  can  be  prevented  by  making  factory 
machinery  safe.  Factory  machinery  will  be  safe  when  the 
state  makes  a  careful  inspection  of  all  machinery  just  as 
some  states  now  make  of  steam  boilers.  Such  inspections 
not  only  save  lives  but  save  money. 

The  last  case  of  sepsis  was  about  the  boy  who  ran  a  thorn 
into  his  foot.  In  case  of  a  punctured  wound  of  that  kind, 
you  should  always  think  of  the  danger  of  a  foreign  body  and 
the  danger  of  tetanus.  The  serum  which  prevents  tetanus 
should  be  given  and  the  wounds  should  be  examined  for  a 
foreign  body.  A  piece  of  sock  was  removed  in  this  case. 
Cases  have  occurred  in  which  an  infection  has  gone  on  for 
weeks  and  a  piece  of  sock  was  finally  found  at  autopsy. 


188          THE  CASE-SYSTEM  OF  HYGIENE 

The  seventh  case  was  about  the  little  girl  who  had  tra- 
choma. Trachoma  causes  a  great  ideal  of  blindness.  It  is 
spread  from  the  eyes  by  means  of  fingers  and  intermediate 
objects.  It  can  be  prevented  by  having  people  with  the  dis- 
ease wear  distinctive  glasses  and  by  keeping  people  with  the 
disease  out  of  this  country.  In  this  country  we  have  very 
few  cases  in  comparison  to  the  number  they  have  in  European 
countries.  Cases  of  trachoma  should  be  isolated.  It  is 
very  hard  to  do  this  because  the  disease  lasts  so  long. 

The  last  case  was  about  the  baby  who  had  ophthalmia. 
Babies  get  all  sorts  of  inflammations  of  the  eyes  from  germs. 
Some  of  these  inflammations  can  be  prevented  by  putting 
a  few  drops  of  weak  silver  nitrate  solution  into  the  eyes  of 
every  baby  when  it  is  born.  Any  case  of  eye  trouble  should 
be  looked  upon  with  suspicion.  If  it  discharges  pus,  a  doctor 
should  see  it  at  once.  It  often  happens  that  the  early 
treatment  of  these  cases  will  prevent  blindness. 


i92          THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    33 

James  M.,  aged  sixty-one  years,  the  superintendent  of  a 
large  hospital,  noticed  that  most  of  the  accidents  which 
occurred  to  working  men  who  came  to  the  hospital,  happened 
on  Monday. 

Why  do  you  think  most  of  the  accidents  happened  on  Monday? 


i94          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    33 

Most  of  the  accidents  happened  on  Monday  because  the 
men  had  been  drinking  liquor  on  Saturday  and  Sunday. 
For  a  great  many  workmen,  Sunday,  instead  of  being  a  day 
on  which  to  get  a  rest  and  allow  their  bodies  to  re-create 
themselves,  is  a  day  on  which  they  tear  their  bodies  down. 
Then  they  cause  accidents,  not  only  to  themselves  but  to 
others.  A  good  many  firms  pay  their  men  Monday  night 
instead  of  Saturday  night  for  this  reason. 

The  reason  these  accidents  occur  is  because  alcohol  up- 
sets the  brain  and  the  nervous  system  of  the  workman 
enough  so  that  he  is  not  as  alert  and  keen  as  he  usually  is. 
Then  accidents  occur. 

SUMMARY   OF   PRACTICAL    POINTS 

I.  Diagnosis.  Alcohol. 

II.  Symptoms.  Accidents  on  Monday. 

III.  Cause.  Drinking   liquor   on    Saturday 

and  Sunday  upset  brains  and 
nervous  systems. 

IV.  Prevention.  Total  abstinence. 


196          THE  CASE-SYSTEM  OF  HYGIENE 


CASE   NO.    34 

In  1906,  Dr.  Warren,  the  State  Food  Commissioner  for 
the  State  of  Pennsylvania,  issued  a  statement  in  which  he 
said:  "A  certain  adulterated  substance  is  about  to  flood  the 
market.  It  will  cause  atrophy  of  nerves,  convulsions,  im- 
paired vision,  blindness,  and  even  death.  Intestinal  de- 
rangement, dyspepsia,  and  kidney  disease  will  also  be  caused 
by  this  substance  and  the  adulterants  in  it." 

What  do  you  think  the  substance  was? 


i98          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    34 

The  substance  was  adulterated  liquor.  All  sorts  of  things 
were  put  into  it.  Wood  alcohol,  fusel  oil,  red  pepper, 
strychnine,  and  other  adulterants  were  added.  As  you  see, 
it  caused  more  diseases  than  the  average  patent  medicine 
is  claimed  to  cure.  Unlike  the  claims  of  the  patent  medicine 
it  did  cause  them. 

The  liquor  itself  is  bad  enough,  if  it  is  pure.  There  is  no 
doubt  that  a  great  deal  of  the  liquor  which  is  sold  is  not  pure. 
Beer,  wine,  brandy,  and  whiskey  are  all  apt  to  be  adulter- 
ated. Then  the  person  gets  both  the  effect  of  the  alcohol 
and  the  effect  of  the  adulterant.  All  of  the  things  men- 
tioned are  produced. 

The  national  pure  food  law  requires  that  the  label  state 
how  much  alcohol  any  patent  medicine  contains.  In  spite 
of  the  pure  food  law,  a  great  many  alcoholic  liquors  are  adul- 
terated. The  only  safe  policy  to  pursue  in  regard  to  liquor 
is  to  let  it  alone. 


SUMMARY   OF   PRACTICAL   POINTS 

I.  Diagnosis.  Adulterated  liquor. 

II.  Symptoms.  All  sorts  of  diseases. 

III.  Cause.  Alcohol    and    adulterants    put 

into  liquor. 

IV.  Prevention.  Total  abstinence. 


200          THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    35 

Life  Insurance  Companies  have  to  know  about  the  lives  of 
the  thousands  of  people  they  insure.  They  have  studied 
thousands  of  cases  carefully  and  have  found  that  one  class 
of  people  live  shorter  lives  than  other  people.  Life  Insur- 
ance Companies  use  this  knowledge  for  the  purpose  of  mak- 
ing money.  No  theory  or  sentiment  enters  into  the  question. 

What  do  you  think  the  short-lived  class  of  people  are? 


202          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    35 

The  people  who  are  short  lived  are  the  alcohol  users, 
From  the  evidence  the  Life  Insurance  Companies  have  col- 
lected there  is  no  doubt  about  this  fact.  If  you  use  alcohol, 
it  will  shorten  your  life. 

Not  only  will  it  shorten  your  life  but  it  will  make  your 
life  a  very  different  thing  than  it  would  have  been  without 
alcohol.  The  use  of  alcohol  affects  the  brain  enough  to 
change  a  person's  entire  mental  attitude  toward  life.  Whether 
you  enjoy  life  or  not,  or  whether  you  do  anything  that  makes 
it  worth  living,  depends  upon  the  attitude  of  your  mind. 
A  person  whose  brain  is  under  the  influence  of  alcohol  sees 
things  falsely  and  fills  his  mind  with  all  sorts  of  false  ideas 
instead  of  filling  it  with  truths.  When  he  comes  to  act  upon 
his  false  ideas  he  gets  into  trouble.  When  people  act  upon 
ideas  that  are  truths  and  realities  they  do  not  get  into  trouble. 

SUMMARY   OF    PRACTICAL   POINTS 

I.  Diagnosis.  Users  of  Alcohol. 

II.  Symptoms.  Shortness  of  life. 

III.  Cause.  Different  weakening  effects  of 

alcohol. 

IV.  Prevention.  Total  abstinence. 


204          THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    36 

In  a  consumptive  hospital  in  Germany,  only  6  per  cent 
of  the  inmates  had  not  used  a  certain  substance  before  get- 
ting the  disease. 

What  was  the  substance? 


206          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    36 

The  substance  was  alcohol.  There  is  no  doubt  that  the 
use  of  alcohol  predisposes  to  tuberculosis.  Not  only  does  it 
make  a  person  more  apt  to  catch  the  disease  but  after  the 
person  has  had  it,  it  makes  him  less  apt  to  get  well. 

People  suffering  with  tuberculosis  often  ask  doctors  what 
the  outlook  for  them  is.  No  doctor  will  answer  without 
asking  whether  the  person  is  a  drinker  or  not.  If  he  is  a 
drinker,  the  doctor  will  usually  say  he  will  not  get  well.  He 
knows  that  every  time  the  person  becomes  intoxicated  he 
will  be  a  good  deal  worse,  or,  if  the  person  uses  liquor  every 
day,  the  doctor  knows  that  it  will  lessen  his  resistance  to  the 
germs  of  tuberculosis  enough  so  that  he  cannot  overcome 
them. 

Alcohol  lessens  the  resistance  of  the  white  blood  cells, 
which  as  you  know  kill  disease  germs.  The  white  blood  cells 
of  an  alcohol  user  will  not  kill  as  many  disease  germs  as  the 
white  blood  cells  would,  if  he  were  a  non-alcohol  user. 

SUMMARY    OF    PRACTICAL    POINTS 

I.  Diagnosis.  Alcohol. 

II.  Symptoms.  Tuberculosis. 

III.  Cause.  Alcohol    weakens     the    white 

blood  cells  of  people.  Then 
the  germs  of  tuberculosis 
attack  them. 

IV.  Prevention.  Total  abstinence. 


208          THE  CASE-SYSTEM  OF  HYGIENE 


CASE   NO.    37 

In  a  certain  ten  families  there  were  fifty-seven  children. 
Of  these  children  ten  were  deformed,  six  were  idiots,  four 
epileptics,  and  twenty-five  died.  Only  ten  were  normal  and 
healthy.  In  ten  other  families  there  was  sixty-one  children. 
Two  were  deformed.  Five  died.  Fifty-four  were  normal 
and  healthy. 

Why  do  you  think  there  was  so  much  difference  between  the  two 
groups  ? 


210         THE  CASE-SYSTEM  OF  HYGIENE 

DISCUSSION CASE    NO.    37 

In  the  first  group  both  parents  were  drinkers.  In  the 
second  group  neither  were.  Not  only  does  alcohol  affect 
the  person  who  uses  it  but  it  also  affects  the  children. 
Children  of  alcoholic  parents  are  not  only  inferior  in  body 
but  they  are  inferior  in  mind.  Numerous  investigations  of 
people  have  proved  that  fact.  It  has  been  shown  as  well 
in  experiments  on  animals.  Dr.  Hodge,  who  experimented 
upon  dogs  with  alcohol,  became  famous  because  of  the 
great  importance  of  his  discoveries.  Two  dogs,  who 
had  had  alcohol  regularly,  in  four  years  had  twenty-three 
puppies.  Many  of  them  were  deformed  and  many  of  them 
died.  Only  four  grew  up.  During  the  same  time  the  two 
dogs  that  had  never  had  any  alcohol  had  forty-five  puppies. 
Only  four  were  deformed.  Forty-one  lived. 

You  can  see  what  a  bad  thing  this  is  for  a  nation.  If  a 
large  number  of  the  people  drink,  almost  all  of  the  children 
will  be  children  of  parents  who  have  used  alcohol.  That 
will  mean  that  the  nation  will  consist  of  people  who  have 
been  weakened  by  alcohol.  There  is  no  doubt  that  any  na- 
tion can  strengthen  itself  by  prohibiting  the  use  of  alcohol. 
A  world  without  liquor  would  be  a  much  better  world. 

SUMMARY   OF    PRACTICAL    POINTS 

I.  Diagnosis.  Alcohol. 

II.  Symptoms.  Difference    between    the    two 

groups. 

III.  Cause.  Bad   effects   of  alcohol  trans- 

mitted in  families. 

IV.  Prevention.  Total  abstinence. 


212          THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    38 

In  England,  Ireland,  and  Wales,  it  is  estimated  that  20 
per  cent,  of  the  insanity  is  due  to  the  use  of  a  certain  sub 
stance. 

What  do  you  think  this  substance  is? 


2i4          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    38 

The  substance  is  alcohol.  The  word  "insanity'*  as  used 
in  this  case  is  not  properly  used.  It  should  read  20  per 
cent,  of  the  inmates  of  the  insane  asylums  are  there  because 
of  alcohol.  By  no  means  all  of  the  people  who  have  minds 
so  deranged  that  they  can  be  said  to  be  insane  are  in  an 
insane  asylum.  Most  of  the  people  who  are  insane  because 
of  alcohol  are  only  partly  insane.  The  people  who  are  only 
partly  insane  are  not  in  insane  asylums. 

There  is  no  doubt  that  alcohol  does  have  a  very  bad  effect 
on  communities  and  upon  the  world  as  a  whole.  It  produces 
a  great  deal  of  inefficiency  on  the  part  of  workmen;  many 
accidents;  much  crime;  much  disease;  considerable  insanity; 
and  many  paupers.  It  makes  the  world  a  less  desirable 
place  for  the  human  race  than  it  would  be  without  liquor. 

SUMMARY   OF    PRACTICAL    POINTS 

I.  Diagnosis.  Alcohol. 

II.  Symptoms.  Insanity  and  partial  insanity. 

III.  Cause.  Effect  of  alcohol  on  brain. 

IV.  Prevention.  Total  abstinence. 


216          THE  CASE-SYSTEM  OF  HYGIENE 


CASE   NO.   39 

John  L.,  aged  fifty-seven  years,  a  judge  in  a  criminal  court 
had  tried  a  good  many  thousands  of  criminals.  He  said 
that  most  of  the  criminals  showed  a  common  cause  for  their 
crimes. 

What  do  you  think  was  the  common  cause  of  their  crimes? 


2i8          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    39 

The  common  cause  of  their  crimes  was  alcohol.  This 
case  tells  the  same  story  as  all  of  the  others.  Alcohol  does 
do  a  great  deal  of  harm. 

SUMMARY   OF   PRACTICAL   POINTS 

I.  Diagnosis.  Alcohol. 

II.  Symptoms.  Crime. 

III.  Cause.  General  demoralizing  effects  of 

alcohol. 

IV.  Prevention.  Total  abstinence. 


220          THE  CASE-SYSTEM  OF  HYGIENE 


CASE   NO.    40 

In  a  school  in  Chicago,  out  of  one  hundred  and  twenty-five 
who  used  a  certain  substance  only  two  were  able  to  keep  up 
with  the  class.  Out  of  two  thousand  four  hundred  and  two 
school  children  in  Chicago,  who  used  this  substance,  only 
6  per  cent,  could  keep  up  with  the  class. 

What  do  you  think  the  substance  was  ? 


222          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.   40 

The  substance  was  alcohol.  The  same  story  over  again. 
Alcohol  is  bad  for  a  great  many  reasons  as  you  have  already 
seen. 

SUMMARY   OF    PRACTICAL   POINTS 

I.  Diagnosis.  Alcohol. 

II.  Symptoms.  Failure  of  pupils. 

III.  Cause.  Alcohol  dulls  brains. 

IV.  Prevention.  Total  abstinence. 


224         THE  CASE-SYSTEM.  OF  HYGIENE 


CASE   41 

During  the  Boer  War  the  officers  in  South  Africa  com- 
plained a  great  deal  about  the  condition  of  the  recruits  that 
came  from  England.  Instead  of  being  alive  and  vigorous, 
the  men  were  listless  and  sleepy.  All  that  these  men  wanted 
to  do  was  to  dodge  the  officers  and  go  to  sleep.  The  officers 
said  it  would  take  three  years  of  feeding  and  drilling  to  get 
the  men  fit  to  be  soldiers. 

Why  were  the  soldiers  who  came  from  England  weak? 


226          THE  CASE-SYSTEM  OF  HYGIENE 

DISCUSSION — CASE    NO.    4! 

They  were  weak  because  they  had  been  using  tobacco. 
The  nicotine  in  the  tobacco  had  dulled  their  brains  and  made 
them  listless,  dull,  and  weak.  It  had  taken  all  of  the  life 
out  of  them.  That  is  what  it  does  to  every  one  who  uses  it. 
People  who  use  it  do  not  know  that  it  has  that  effect  because 
their  brains  are  dulled  by  it  and  they  cannot  judge. 

Usually  people  of  this  kind  keep  on  weakening  themselves 
with  tobacco  until  they  either  have  to  quit  or  until  they  die 
several  years  before  they  ought  to  die.  It  often  weakens 
people  so  that  they  get  some  other  sickness.  That  may 
carry  them  off  or  it  may  make  life  very  miserable  for  them. 

These  soldiers  were  fortunate  in  having  a  chance  to  get 
into  good  condition  again.  Once  the  average  person  gets 
himself  out  of  condition  it  is  hard  for  him  to  get  back  and  do 
his  work  at  the  same  time.  He  never  recovers  fully.  When 
a  person  has  been  weakened  by  tobacco  the  only  thing  for 
him  to  do  is  to  stop  and  try  to  get  into  good  condition  again 
by  leading  a  very  perfect  sort  of  a  life.  That  means  he  must 
have  regular  habits  of  sleep,  exercise,  eating,  bathing,  and 
working.  He  must  do  everything  by  the  clock.  The  best 
thing  to  do  is  not  to  use  tobacco  at  all.  Then  you  will  not 
become  that  sort  of  a  person.  You  will  want  to  take  exercise 
and  do  things  to  keep  yourself  in  good  condition. 

SUMMARY   OF    PRACTICAL    POINTS 

I.  Diagnosis.  Nicotine. 

II.  Symptoms.  Weakness  and  listlessness. 

III.  Cause.  Nicotine  dulls  the  brain. 

IV.  Preventive  treatment.  Get  into  good  condition. 
V.  Prevention.  Abstain  from  tobacco. 


228          THE  CASE-SYSTEM  OF  HYGIENE 


CASE   42 

At  Yale  University  the  students  were  divided  into  four 
groups  according  to  their  standing  in  class;  only  24  per  cent, 
of  the  first  group  used  a  certain  substance;  85  per  cent,  of  the 
lowest  group  used  it. 

What  do  you  think  this  substance  was  ? 


230         THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    42 

The  substance  was  tobacco.  You  can  see  what  the  effect 
was  on  the  minds  of  the  college  students.  It  has  the  same 
effect  upon  the  minds  of  every  one  else.  When  nicotine  is 
taken  into  the  body  it  is  absorbed  into  the  blood  and  circu- 
lated to  the  brain.  At  the  time  a  person  is  smoking  or 
chewing  the  brain  seems  to  be  soothed.  In  reality,  it  is 
only  dulled.  While  it  is  being  dulled,  it  is  being  weakened. 

The  outlook  for  these  two  groups  of  men  is  very  different. 
The  chances  are  that  the  men  in  the  first  group  will  be  the 
leading  men  in  our  nation  in  a  few  years.  The  men  in  the 
second  group  are  not  as  apt  to  be  successful.  Of  course 
they  could  increase  their  chances  for  success  by  stopping 
tobacco  and  keeping  themselves  in  excellent  condition. 

If  any  one  ever  tells  you  that  your  standing  in  school  does 
not  make  any  difference,  you  must  not  believe  him.  The 
facts  are  that  the  men  who  stand  high  in  college  are  the  men 
who  later  make  a  success  in  life.  Of  the  honor  men  who 
graduated  from  Harvard  only  20  per  cent,  are  not  to  be 
found  in  the  directory  of  successful  people  of  the  United 
States.  This  directory  is  called  "Who's  Who." 

If  you  are  wise,  you  will  not  have  anything  to  do  with  the 
habit-forming  drugs  which  effect  your  brain.  Your  brain 
is  a  very  poor  thing  to  fool  with.  That  is  what  you  are  doing 
when  you  use  any  of  the  habit-forming  drugs:  alcohol, 
nicotine,  theine,  or  caffeine. 


BOOK  SEVEN  231 


SUMMARY   OF   PRACTICAL   POINTS 

I.  Diagnosis.  Nicotine. 

II.  Symptoms.  Difference  in  standing. 

•III.  Cause.  Nicotine  dulls  the  brain. 

IV.  Prevention.  Avoid  all  habit-forming  drugs. 

SUMMARY   NO.    5 

The  last  ten  cases  have  all  been  about  the  use  of  alcohol 
and  tobacco.  From  them  we  may  learn  several  general 
lessons. 

1.  Total  abstinence  is  the  best  policy  to  pursue  toward  all 
of  the  habit-forming  drugs. 

2.  Alcohol  is  objectionable  because  it  injures  a  person's 
mind,  body,  personality,  and  character. 

3.  Alcohol  is  injurious  to  any  community,  state,  nation, 
and  the  world  as  a  whole.     It  produces  disease,  accidents, 
inefficiency,  crime,  insanity,  and  pauperism. 

4.  Alcohol  makes  people  short  lived. 

5.  The  injurious  effects  of  alcohol  are  handed  down  from 
parent  to  child. 

6.  The  correct  policy  for  you  to  pursue  in  regard  to  to- 
bacco is  total  abstinence. 

7.  Tobacco   is   objectionable    because   it   interferes   with 
growth,  interferes  with  the  working  of  the  mind,  leads  to 
disease,  causes  a  great  deal  of  loss  of  time,  and  handicaps  the 
user  in  the  battle  of  life. 


234          THE  CASE-SYSTEM  OF  HYGIENE 


CASE  43 

Anna  C.,  aged  seven  years,  was  playing  around  a  manure 
pile  while  the  men  were  pitching  it  upon  wagons.  By  acci- 
dent one  of  the  men  ran  a  pitchfork  about  two  inches  into 
her  foot.  Her  mother  cleaned  the  foot  up  carefully  and  put 
turpentine  on  the  wound. 

What  disease  is  the  little  girl  in  danger  of  getting? 


236          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    43 

The  little  girl  is  in  danger  of  developing  tetanus.  We 
have  studied  cases  of  tetanus  before  but  we  have  not  learned 
how  the  disease  is  spread.  The  germs  of  the  disease  are 
found  in  horse  manure.  Consequently,  any  wound  which  is 
closed  to  the  air  and  has  been  contaminated  by  horse  manure, 
as  this  wound  from  the  pitchfork  and  the  manure  pile  prob- 
ably was,  is  a  very  dangerous  wound.  Any  soil  which  con- 
tains any  manure  is  apt  to  contain  the  germs  of  the  disease. 

This  girl  did  develop  the  disease  ten  days  later  and  after 
going  through  all  the  stages  of  convulsions  and  lockjaw,  died. 
After  a  person  gets  the  disease,  no  treatment  for  it  is  effec- 
tive. As  you  know,  tetanus  serum  is  a  very  good  preventive 
treatment  and  should  be  injected  for  every  deep  wound  that 
is  closed  to  the  air. 

The  disease  should  be  kept  from  occurring  at  all.  Horse 
manure  should  be  as  carefully  disposed  of  as  any  sort  of 
sewage.  There  should  be  no  open  manure  piles  and  manure 
boxes.  Manure  should  be  packed  in  covered  galvanized  iron 
barrels  or  cans.  Not  only  do  the  germs  of  tetanus  occur  in  it 
but  it  affords  a  place  for  flies  to  develop.  If  all  manure  were 
covered  so  that  the  flies  could  not  get  at  it,  there  would  be 
no  flies. 

Flies  are  great  carriers  of  disease.  They  get  into  the  ex- 
cretions from  persons  who  have  all  sorts  of  diseases,  measles, 
scarlet  fever,  whooping  cough,  infantile  paralysis,  dysentery, 
typhoid  fever,  and  cholera.  They  get  the  germs  of  these 
diseases  on  their  feet  and  leave  them  wherever  they  alight. 
It  often  happens  that  such  a  germ-laden  fly  alights  on  a  human 
being's  food.  Then  he  develops  the  disease  the  fly  was  carry- 


BOOK  SEVEN 


237 


ing  around  on  his  feet.  See  to  it  that  manure  is  properly 
disposed  of  in  your  community.  Remember  that  it  is  a 
menace  to  public  health.  Keep  your  streets  washed  up  and 
swept  up.  The  greater  part  of  horse  manure  is  made  up  of 
germs. 


SUMMARY   OF    PRACTICAL    POINTS 


I.  Diagnosis. 
II.  Symptoms. 

III.  Cause 


IV.  Treatment. 
V.  Preventive 

VI.  Prevention. 


Tetanus. 

1.  Convulsions. 

2.  Lockjaw. 

1.  Germs  of  tetanus  attacking 
spinal  cord. 

2.  Germs  of  tetanus  in  horse 
manure. 

3.  Germs  of  tetanus  get  into 
body  in  deep  wounds  which 
are  closed  to  the  air. 

None. 

treatment.  Anti-tetanus    serum   in    every 
case  of  deep,  closed  wound. 

Proper  disposal  of  manure. 


238          THE  CASE-SYSTEM  OF  HYGIENE 


CASE  44 

Mollie  R.,  aged  six  months,  began  to  fret  and  toss  on 
August  1 6th.  She  would  take  only  half  of  her  feedings,  and 
seemed  as  hot  as  the  air  outside.  At  night  she  slept  very  little 
and  cried  a  great  deal.  On  the  seventeenth,  she  continued 
the  same  way  and  had  three  loose  bowel  movements,  all  a 
little  bit  greenish  and  accompanied  by  some  mucus  and  green 
material.  On  the  eighteenth,  she  refused  to  take  any  of  her 
feedings  and  had  four  similar  movements.  A  friend  told  the 
mother  that  the  milk  was  not  right.  She  had  been  giving 
the  baby  half  store  milk  and  half  water.  The  friend  said 
to  give  the  baby  eight  ounces  of  barley  water  every  three 
hours.  From  the  eighteenth  to  the  twenty-second  the  baby 
was  given  the  barley  water.  The  trouble  did  not  disappear. 

What  will  happen,  if  the  baby  keeps  on  having  barley  water  only? 


240          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    44 

If  a  baby  is  given  only  barley  water  for  any  length  of 
time,  it  will  starve  to  death.  In  previous  lessons  you  have 
learned  that  a  person  needs  a  carefully  balanced  ration;  that 
is,  a  ration  which  is  worth  so  many  calories  or  heat  units 
when  the  fuel  value  of  the  food  is  taken  into  account.  It 
must  also  contain  a  few  ounces  of  mixed  proteins,  a  little 
mineral  matter,  and  portions  of  fat  and  carbohydrate  as  well 
as  protein. 

The  child  has  summer  diarrhoea.  That  means  germs  are 
attacking  the  child's  intestines  and  making  them  move  the 
contents  along  too  rapidly.  The  general  sickness,  fever, 
restlessness,  and  loss  of  appetite  show  that  poisons  from  the 
germs  were  being  absorbed  from  the  intestines  and  circulated 
all  over  the  body. 

•The  disease  or  group  of  diseases  which  are  called  summer 
diarrhoea  is  spread  by  milk,  especially  store  milk.  You  have 
learned  before  how  important  it  is  that  people  have  pure 
milk.  This  is  doubly  true  of  babies. 

It  makes  considerable  difference  how  a  case  of  summer 
diarrhoea  is  treated.  If  things  are  given  to  check  the  diar- 
rhoea, the  baby  usually  dies.  If  things  are  given  to  clean 
the  baby  out  and  to  wash  out  its  bowels,  the  baby  usually 
gets  well.  This  baby  was  given  things  to  check  the  diar- 
rhoea. It  promptly  developed  convulsions  and  died. 

Thousands  of  babies  are  lost  in  the  United  States  from  this 
cause  every  year.  Avoiding  bottle  feeding  altogether  and 
feeding  from  the  breast  is  the  greatest  measure  of  preven- 
tion that  can  be  taken.  If  the  baby  has  to  be  fed  on  arti- 
ficial feedings,  pure  cow's  milk  modified  to  suit  each  baby 


BOOK  SEVEN  241 

should  be  used.  The  only  person  who  knows  how  to  modify 
milk  is  a  doctor.  It  is  perfectly  fair  to  say  that  not  all  of 
them  know.  Consequently,  if  the  baby  is  to  be  fed  arti- 
ficially, the  feeding  should  be  supervised  by  a  doctor  who 
does  know  how. 

In  cities  specialists  for  babies  and  children  can  usually  be 
found.  If  a  person  is  too  poor  to  patronize  such  a  specialist, 
they  can  be  usually  seen  at  free  dispensaries  and  hospitals. 
In  the  country,  the  family  doctor  will  always  tell  you 
whether  he  understands  infant  feeding  or  not,  and  if  he  does 
not,  will  recommend  some  one  else. 

The  best  cow's  milk  is  certified  milk.  The  next  best  is 
pasteurized  milk.  Any  milk  that  is  not  certified  should  be 
pasteurized  before  being  given  to  a  baby.  That  will  prevent 
a  great  many  cases  of  summer  diarrhoea. 

SUMMARY   OF    PRACTICAL   POINTS 

I.  Diagnosis.  Infant  diarrhoea. 

II.  Symptoms.  Diarrhoea. 

III.  Cause.  i.  Germs  attacking  intestines. 

2.  Germs    come    from    impure 
milk. 

IV.  Treatment.  Clean  intestines  out. 

V.  Prevention.  i.  Breastfeeding. 

2.  Certified  milk 

3.  Modified  milk. 

4.  Pasteurized  milk. 


242          THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.   45 

Mr.  R.  D.,  aged  twenty-two  years,  a  grocer  in  San  Fran- 
cisco, was  taken  ill  on  August  ist.  He  had  diarrhoea  and  felt 
weak  and  feverish.  On  August  2d  his  bowels  ran  off  like 
water  every  few  minutes.  He  became  very  sick.  Suddenly 
about  ten  o'clock  in  the  morning  he  fainted.  When  he 
revived,  he  lay  in  a  cold  sweat  and  was  absolutely  prostrated. 
He  sank  gradually  into  a  stupor  and  died  at  3  p.  M. 

What  do  you  think  is  the  matter  with  the  man  ? 


244 


THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    45 

The  sudden  onset  of  diarrhoea  and  the  fact  that  the  man 
is  so  very  sick  and  prostrated  right  at  the  start  is  typical  of 
cholera.  Cholera  germs  were  found  in  the  discharges  from 
this  man's  intestines.  The  disease  is  spread  from  these 


The  germs  of  cholera 

intestinal  discharges.  Fingers  are  contaminated  with  the 
discharges  and  flies  get  into  them.  If  the  discharges  are  not 
properly  disposed  of,  other  animals,  such  as  rats,  get  into 
them.  From  fingers  and  flies  the  discharges  get  into  food. 
When  people  eat  the  contaminated  food,  they  get  the  dis- 
ease. The  disease  occurs  only  in  countries  where  sewage  is 
improperly  disposed  of,  such  as  China  and  India.  There 
streams  are  polluted,  and  the  germs  get  into  the  drinking 
water.  Then  whole  cities  get  it. 


BOOK  SEVEN  245 

Once  a  person  has  the  disease,  very  little  can  be  done. 
Most  of  the  people  who  get  it  die  in  the  first  three  days.  If 
they  get  past  the  first  three  days,  the  outlook  is  good. 

The  disease  can  be  prevented  by  isolating  cases  of  the 
disease.  Our  marine  hospital  service  keeps  cases  out  of  the 
country  by  isolation  and  by  allowing  no  one  to  land  from  a 
ship  where  there  has  been  a  case  of  cholera  until  they  see 
whether  any  new  cases  develop.  This  affair  of  holding  up 
a  ship  on  account  of  the  disease  is  called  quarantining  it. 

Another  remedy  for  the  prevention  of  the  disease  is  the 
proper  disposal  of  sewage.  If  sewage  is  allowed  to  run  into 
streams  which  are  used  for  drinking  water,  all  of  the  diseases 
which  come  from  the  intestinal  tract  are  bound  to  occur. 
Large  and  small  cities  should  have  a  system  of  sewers.  These 
sewers  should  empty  into  filter  beds  where  the  germs  in  the 
sewage  will  be  destroyed.  As  you  know,  the  great  bulk  of 
sewage  is  made  up  of  germs.  The  sewage  should  not  be 
poured  unfiltered  into  streams. 

The  vaccine  against  cholera  is  very  effective.  During 
the  war  between  Russia  and  Japan  all  of  the  Japanese  sol- 
diers were  vaccinated  against  cholera.  Almost  none  of  them 
had  the  disease.  The  Russians  were  not  vaccinated. 
Thousands  of  them  died  from  it.  In  case  of  an  epidemic, 
every  one  who  has  been  exposed  or  may  be  exposed,  should 
be  vaccinated  with  the  cholera  vaccine. 


SUMMARY    OF    PRACTICAL    POINTS 

I.  Diagnosis.  Cholera. 

II.  Symptoms.  I.  Severe  diarrhoea. 

2.  Extreme  prostration. 


246 


THE  CASE-SYSTEM  OF  HYGIENE 


III.  Cause. 


IV.  Treatment. 
V.  Preventive  treatment. 


1 .  Cholera  germs  attacking  in- 
testines. 

2.  Poisons  from  cholera  germs 
circulating  all  over  body. 

None. 

1.  Vaccine  against  cholera. 

2.  Proper  sewage  disposal. 

a.  Sewers. 

b.  Filter  beds. 


248          THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    46 

The  city  of  A.  takes  its  supply  of  water  from  the  B.  River. 
Several  cities  above  A.  on  the  B.  pour  their  sewage  into  it. 
Before  the  water  is  used  at  A.  it  is  run  through  a  filter  plant 
where  the  water  is  made  to  pass  through  filters  of  sand  and 
stone.  After  the  water  gets  through  the  filters  it  is  treated 
with  hypochlorite  of  lime,  a  chemical  which  kills  off  most  of 
the  germs  that  remain  in  the  water. 

The  city  of  C.  thirty  miles  below  A.  on  the  B.  River  gets 
its  water  by  pumping  it  from  deep  wells  which  have  been 
sunk  down  alongside  of  the  river. 

Which  city  has  the  better  plan  for  getting  its  water? 


250          THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    46 

It  is  a  poor  plan  to  take  drinking  water  from  streams. 
They  are  often  carriers  of  disease.  It  is  much  better  to  dig 
deep  wells  alongside  of  the  stream  and  take  the  water  from 
them.  That  is  done  at  C.  The  water  has  the  benefit  of  a 
natural  filter  where  the  water  filters  through  a  very  large 
body  of  earth.  In  an  artificial  filter  it  goes  through  only  a 
few  feet  of  sand  and  rock.  These  natural  filters  are  so  much 
larger  than  any  artificial  filtering  plant  that  they  are  better. 
They  are  also  much  cheaper  to  build  and  to  operate.  The 
cost  of  pumping  the  water  is  not  as  much  as  the  cost  of 
operating  a  filtration  plant. 

Small  villages  and  country  houses  which  cannot  have  a 
system  of  sewers  can  have  privies  which  will  dispose  of  sew- 
age properly.  A  privy  may  be  made  by  digging  a  hole  in  the 
ground.  The  hole  should  be  located  at  least  two  hundred 
feet  from  the  well  and  so  placed  that  the  water  will  drain 
away  from  the  well.  The  bottom  of  the  hole  should  contain 
three  feet  of  sand.  Over  this  hole  in  the  ground  the  privy 
house  should  be  made.  It  should  be  provided  with  self- 
closing  seats,  self-closing  doors,  and  screens  so  that  no  flies 
can  get  into  it.  The  seats  and  door  should  always  be  kept 
closed.  Pails  of  sand  should  also  be  set  inside  of  the  house. 
Whenever  any  sewage  is  deposited,  it  should  immediately 
be  covered  over  with  sand.  At  no  time  should  any  sewage 
be  exposed  so  that  flies  can  get  at  it.  The  sewage  should  be 
caught  in  large  galvanized  iron  pails.  These  pails  may  be 
emptied  by  scavenger  wagons  at  night.  If  the  sewage  is 
scattered  out  over  a  field,  the  germs  in  it  are  killed  by  the 
sunlight  and  drying.  If  the  sewage  is  buried  in  a  privy  hole, 


BOOK  SEVEN 


251 


a  lasting  menace  to  health  is  established  or,  if  it  is  scattered 
over  the  garden,  the  germs  in  it  get  on  vegetables  and  from 
them  into  food  before  the  germs  have  been  killed  out. 

Wells  should  be  located  on  spots  higher  than  privies  or 
barn  yards.  Otherwise  germs  will  drain  in  with  the  surface 
water. 


SUMMARY   OF    PRACTICAL    POINTS 


I.  Diagnosis. 
II.  Symptoms. 

III.  Cause. 


IV.  Prevention  and  treat- 
ment. 


Wells  better  than  filter  plants. 

1.  Purer  water. 

2.  Cheaper  water. 

Purer  water — better  filtration. 
Cheaper  water — pumping  less 
expensive. 

1.  Have  wells  rather  than  filter 
plants. 

2.  Keep  streams  pure. 

a.  By  good  sewerage  systems. 

b.  By  sanitary  privies. 


'Anyone  interested  in  the  question  of  natural  versus  artificial  filtration  should 
investigate  the  waterworks  at  Camden,  N.  J. 


252          THE  CASE-SYSTEM  OF  HYGIENE 


CASE    NO.    47 

George  W.  of  M.  H.,  aged  seventeen  years,  awoke  Septem- 
ber 1st  feeling  rather  bad.  He  did  not  have  much  appetite 
for  breakfast.  During  the  afternoon  his  head  began  to 
ache,  and  he  had  pains  in  his  back.  He  felt  out  of  sorts  this 
way  for  over  a  week.  Each  day  he  felt  a  little  worse  than 
the  day  before,  but  he  took  two  or  three  headache  tablets 
each  day  which  made  him  feel  less  miserable.  In  this  way 
he  managed  to  keep  going  about.  On  the  tenth  day  he  felt 
a  sudden  severe  pain  in  the  pit  of  the  stomach.  He  vomited 
and  had  to  lie  down. 

What  do  you  think  is  the  matter  with  the  man? 


254 


THE  CASE-SYSTEM  OF  HYGIENE 


DISCUSSION — CASE    NO.    47 

The  slow  onset  is  characteristic  of  typhoid  fever.  In 
typhoid  fever  the  germs  attack  the  intestines  and  form  small 
ulcers  in  them.  It  sometimes  happens  that  one  of  the  ulcers 


The  germs  of  typhoid  fever  make  sores  of  this  kind  in  the 
small  intestines 

perforates  and  makes  a  hole  in  the  intestine.  That  is  what  is 
the  matter  here  and  why  the  man  had  a  sudden  pain  in  the 
pit  of  the  abdomen.  He  chanced  to  fall  into  the  hands  of  a 
very  skillful  doctor  who  suspected  that  the  man  had  had 
typhoid  fever  and  had  a  perforation  of  the  intestines.  An 


BOOK  SEVEN  255 

operation  was  immediately  resorted  to.  The  hole  in  the 
man's  intestines  was  found  and  sewed  up.  The  germs  which 
had  poured  out  into  his  abdomen  were  allowed  to  drain  out. 
For  two  months  he  was  a  very  sick  man  but  pulled  through. 

The  germ  which  causes  typhoid  fever  is  the  typhoid  bacil- 
lus. It  is  spread  in  very  much  the  same  way  that  the  germs 
of  cholera  are  spread;  that  is,  from  the  discharges  of  the  intes- 
tines by  means  of  flies,  ringers,  milk,  drinking  water,  and 
food.  Typhoid  is  always  most  prevalent  in  the  fall  when 
there  are  a  great  many  flies.  The  disease  is  kept  alive  by  hu- 
man carriers.  Some  people  have  the  germs  in  their  intestines 
after  they  get  wrell  and  keep  carrying  them  around  and  give 
them  to  other  people.  Typhoid  Mary  is  known  to  have 
caused  over  a  hundred  cases  of  typhoid  ^nd  to  have  caused 
more  than  twenty  deaths. 

This  man  caught  the  disease  from  drinking  water.  Towns 
above  M.  H.  on  the  creek  from  which  it  took  its  water  sewered 
into  the  streams.  Almost  every  fall  M.  H.  had  an  epidemic 
of  typhoid. 

Good  management  and  good  nursing  count  for  a  great 
deal  in  the  treatment  of  typhoid,  but  many  of  the  people 
who  get  typhoid  die  of  it.  Cases  of  walking  typhoid,  such 
as  this  one,  are  especially  bad  because  the  person's  strength 
is  all  gone  and  he  has  none  left  to  fight  the  disease  with. 

The  preventive  treatment  for  the  disease,  the  typhoid 
vaccine,  is  very  effective.  Since  the  vaccine  against  ty- 
phoid fever  has  been  used  in  the  army,  they  have  had  almost 
no  cases  of  the  disease.  Formerly  they  had  a  great  many. 
There  is  no  doubt  that  its  use  should  be  compulsory  all  over 
the  United  States.  If  it  were,  typhoid  would  soon  disappear. 
If  you  have  not  been  vaccinated  for  typhoid,  get  vaccinated! 

The  disease  can  be  prevented  from  occurring  altogether 


256          THE  CASE-SYSTEM  OF  HYGIENE 

by  the  proper  disposal  of  sewage,  procuring  pure  milk  and 
water,  and  keeping  carriers  of  the  disease  shut  up. 

This  case  shows  that  patent  medicines  are  not  a  good 
thing.  If  this  man  had  not  been  dulling  his  brain  with  head- 
ache powders,  probably  he  would  have  realized  that  he  was 
sick  and  would  have  gone  to  a  doctor.  Very  few  patent 
medicines  fail  to  contain  a  drug  that  affects  the  brain. 


SUMMARY   OF    PRACTICAL    POINTS 


I.  Diagnosis. 
II.  Symptoms. 

III.  Cause. 


IV.  Treatment. 


V.  Preventive  treatment. 


Typhoid  fever  with  perforation 
of  the  intestines. 

1.  Symptoms  of  a  slowly  start- 
ing infection. 

2.  Sudden  pain  in  abdomen. 

3.  Vomiting. 

1.  Typhoid     germs     attacking 
small  intestine. 

2.  Poison  from  germs  circulat- 
ing all  over  the  body. 

3.  Germs  made  ulcers  in  small 
intestine. 

4.  An  ulcer  perforated. 

5.  Germs    carried    by    human 
carriers. 

1.  Operation  to  sew  up  perfora- 
tion and  drain  abdomen. 

2.  Good  nursing. 

1.  Early  diagnosis   and    treat- 
ment. 

2.  Avoiding  patent  medicines. 


BOOK  SEVEN  257 

VI.  Prevention.  I.  Proper  disposal  of  sewage. 

2.  Prevention  of  flies. 

3.  Compulsory    typhoid    vac- 
cination. 

SUMMARY   6 

The  last  five  cases  have  all  been  about  diseases  which  are 
spread  from  the  discharges  of  the  intestinal  tract.  We  have 
considered  the  diseases  tetanus,  infant  diarrhoea,  cholera, 
and  typhoid  fever.  People  or  "animals  carry  these  diseases 
around  in  their  bodies  and  shed  the  germs  in  the  discharges 
from  the  intestines.  Then  the  germs  get  to  other  people  by 
means  of  impure  drinking  water,  impure  milk,  or  food  that 
has  been  contaminated  with  the  germs  through  the  agency 
of  fingers,  flies,  or  other  intermediate  articles.  In  the  pre- 
vention of  this 'group  of  diseases,  we  learned  how  important 
it  is  that  sewage  be  disposed  of  properly  and  how  important 
it  is  that  pure  drinking  water  and  pure  milk  be  secured. 
Different  things  have  to  be  done  to  prevent  each  disease. 

From  the  first  case,  that  of  the  little  girl  who  got  tetanus 
from  the  stab  of  a  manure  fork,  we  may  learn  several  general 
lessons. 

1.  Tetanus  is  spread  in  horse  manure. 

2.  Any  soil  containing  horse  manure  is  apt  to  contain  the 
germs  of  tetanus. 

3.  The  germs  of  tetanus  will  not  grow,  if  exposed  to  air. 

4.  The  germs  of  tetanus  grow  in  deep,  closed  wounds. 

5.  Tetanus  serum  should  be  given  in  every  case  of  a  deep, 
closed  wound. 

6.  Horse  manure  should  be  disposed  of  just  as  carefully  as 


258          THE  CASE-SYSTEM  OF  HYGIENE 

other  sewage.  Streets  should  be  washed  and  swept  every 
day.  Manure  in  stables  should  be  so  kept  in  that  no  flies 
can  get  into  them. 

7.  Flies  develop  in  horse  manure. 

8.  Flies  carry  a  great  variety  of  diseases  around  on  their 
feet  by  getting  the  germs  on  their  feet. 

The   second   case  was   about  the   baby  who  had   infant 
diarrhoea.     From  it  we  may  learn  several  general  lessons. 

1.  The  germs  in  the  impure  milk  cause  summer  diarrhoea. 

2.  Summer  diarrhoea  may  be  prevented  in  the  best  way  by 
substituting  breast  feeding  for  bottle  feeding. 

3.  Certified  milk  is  the  only  milk  that  is  pure  enough  for 
babies. 

4.  Certified  milk  should  be  modified  to  suit  each  baby's 
particular  requirements. 

5.  Pasteurized  milk  usually  has  the  germs  in  it  cooked  to 
death.     That  can  be  done  at  home. 

6.  Store  milk  is  usually  impure. 

7.  Any  milk  can  be  made  impure  by  leaving  it  off  the  ice 
in  a  warm  place  for  a  few  minutes. 

8.  All  milk  should  be  kept  on  ice  in  warm  weather  and 
should  be  kept  cold  in  cold  weather. 

9.  A  cheap  refrigerator  can  be  made  from  a  tobacco  pail 
and  a  can. 

The  third  case  was  about  the  man  who  had  cholera.     From 
it  we  may  learn  several  general  lessons. 

1.  Cholera   is   a  disease  which  occurs,  if  sewage  is  not 
properly  disposed  of. 

2.  Sewage  that  is  not  properly  disposed  of  gets  into  drink- 
ing water. 


BOOK  SEVEN  259 

3.  Epidemics   of  various   diseases   occur  when   drinking 
water  is  contaminated. 

4.  Such  diseases  can  be  prevented  by  systems  of  sewers 
which   carry  off  the  sewage  and   empty  it  into   filter  beds 
where  the  germs  are  killed. 

5.  The  vaccine  for  cholera  prevents  cholera.     It  should 
be  used  wherever  the  disease  breaks  out. 

From  the  fourth  case,  the  one  which  compared  the  water 
supplies  of  A.  and  C,  we  may  learn  several  general  lessons. 

1.  The  C.  plan  of  securing  a  city  water  supply  is  a  very 
good  plan. 

2.  The  C.  plan  consists  in  digging  deep  wells  near  a  river 
and  allowing  the  earth  to  act  as  a  natural  filter. 

3.  At  C.  this  plan  has  been  found  to  be  better  than  the 
plan  of  having  filtration  plants. 

4.  Whichever  plan  is  used,  streams  should  not  be  polluted 
with  sewage. 

5.  Small  villages  should  dispose  of  their  sewage  by  the  use 
of  sanitary  privies,  scavenger  wagons,  and  the  scattering  of 
sewage  over  fields. 

6.  Sewage  should  not  be  buried  in  a  hole  in  the  ground 
or  put  on  gardens  because  the  germs  might  get  onto  food  or 
into  drinking  water. 

From  the  fifth  case,  that  of  the  young  man  who  had  walk- 
ing typhoid  and  a  perforation  of  the  small  intestine,  we  may 
learn  several  general  lessons. 

1.  Typhoid  fever  is  carried  around  by  human  carriers. 

2.  Carriers  of  the  disease  should  not  be  allowed  at  large. 

3.  The  vaccine  against  typhoid  fever  prevents  the  disease. 

4.  Typhoid  vaccination  should  be  compulsory. 


260          THE  CASE-SYSTEM  OF  HYGIENE 

5.  The  proper  disposal  of  sewage  prevents  the  disease  from 
occurring  at  all. 

6.  Patent  medicines  are  bad  things.     They  dull  the  brain 
and  keep  a  person  from  realizing  the  truth  about  himself* 


262          THE  CASE-SYSTEM  OF  HYGIENE 


CASE  48 

In  1880  John  S.,  aged  twenty-two  years,  was  taken  sick 
with  typhoid  fever.  As  soon  as  the  doctor  said  he  had 
typhoid  fever  all  food  except  clear  soup  and  a  glass  of  milk 
four  times  a  day  was  stopped.  As  he  lay  in  bed  he  tossed 
with  fever  and  often  called  for  water.  He  was  given  only 
half  a  glass  of  warm  water  every  three  hours,  a  quart  daily. 
At  the  end  of  six  weeks  he  was  a  living  skeleton.  He  was  so 
weak  that  he  could  not  hold  up  his  head. 

In  1912,  the  son  of  John  S.,  John  S.,  Jr.,  aged  twenty-two 
years,  was  taken  sick  with  typhoid  fever.  The  doctor 
ordered  that  he  be  given  all  of  the  water  he  wanted  and  spent 
some  time  in  figuring  out  a  diet  which  he  might  be  given 
each  day.  The  only  meat  allowed  was  bacon.  All  foods 
containing  hard  particles  such  as  jam  and  all  foods  containing 
cellulose  such  as  lettuce  and  the  fruits  were  omitted.  He  had 
almost  everything  else.  The  fever  lasted  only  four  weeks. 
During  that  time  the  patient  was  fairly  comfortable.  At 
the  end  he  had  gained  seven  pounds  and  was  not  particularly 
weak. 

Why  the  difference  in  the  two  cases? 


264          THE  CASE-SYSTEM  OF  HYGIENE 

DISCUSSION  CASE  48 

The  first  man  was  suffering  from  typhoid  and  starvation; 
the  second  from  typhoid  only.  In  1880  doctors  had  no  way 
of  telling  how  much  food  nor  what  kind  of  food  a  person's 
body  needs  to  maintain  life.  They  did  not  realize  that  they 
were  starving  their  patients.  Since  that  time  doctors  and 
scientists  have  measured  the  value  of  all  foods  in  terms  of 
calories  or  heat  units.  An  egg  when  burned  in  the  body 
or  elsewhere  gives  off  seventy-five  calories;  a  glass  of  milk, 
one  hundred  and  sixty  calories.  By  consulting  the  adjoined 
tables  you  may  see  that  the  values  of  all  common  foods  have 
been  determined  in  terms  of  calories.  It  has  also  been 
determined  how  much  people  of  different  sizes,  doing  various 
amounts  of  work  need.  As  you  will  see  a  baby  requires 
considerably  less  than  a  boilermaker.  The  substances  in 
foods  have  been  divided  up  into  four  groups;  fats,  proteins, 
carbohydrates,  and  mineral  matter.  Milk  contains  all  of 
them.  In  milk  the  fat  is  cream;  the  protein  is  the  curd 
which  you  see  in  cheese;  the  carbohydrate  is  milk  sugar; 
and  the  mineral  matter  is  made  up  of  a  small  amount  of 
minerals  found  in  the  earth.  All  are,  more  or  less,  com- 
pletely dissolved  in  the  water  which  constitutes  a  large 
part  of  milk.  By  consulting  the  tables  you  will  see  that 
different  foods  contain  different  percentages  of  the  four 
different  substances.  We  call  such  a  food  as  milk  which 
contains  all  of  the  elements  a  well-balanced  food.  Such  a 
food  as  sugar  or  starch  which  contains  only  carbohydrate 
is  an  unbalanced  food.  You  must  not  only  eat  enough  but 
the  entire  diet  which  you  eat  each  day  must  be  well  balanced 
in  regard  to  all  four  of  the  elements.  The  best  way  to  be 


BOOK  SEVEN  265 

sure  of  getting  the  right  things  is  to  eat  a  variety  of  foods. 
When  you  are  eating  enough  food  and  are  getting  the  right 
kinds  we  say  that  you  are  taking  a  balanced  ration;  other- 
wise, an  unbalanced  ration.  In  this  case  the  doctor  avoided 
foods  that  might  irritate  the  typhoid  ulcers  in  the  intestines 
and  gave  the  man  enough  food  and  drink  to  live  on.  The 
first  man  literally  lived  on  his  own  body.  Many  people 
partially  starve  themselves.  You  can  avoid  doing  so  by 
figuring  up  your  meals  occasionally  and  seeing  whether  your 
appetite  leads  you  to  take  a  well  balanced  ration.  Usually, 
it  does.  Sometimes,  it  does  not. 

SUMMARY  OF  PRACTICAL  POINTS 

Diagnosis    .  ,   I.  Balanced  vs.  Unbalanced  Ration. 

Symptoms  .   2.  Loss  of  weight  and  strength. 

Cause    .      .  .3.  Unbalanced  ration. 

Treatment  .   4.  Balanced  ration. 

Prevention  .    5.  Balanced  ration. 


DAILY  FOOD  REQUIREMENTS 


ADULT 

BODY 
WEIGHT 

CALORIES 
PER  POUND 

TOTAL 
CALORIES 

TOTAL  GRAMS 
PROTEIN 

At  rest  in  bed      

150  Ibs. 

12 

I800 

72 

Slight  activity  

1C 

2200 

88 

Light  work  
Moderately  hard  work  .  .  . 
Very  hard  work  

« 
« 
« 

17 

20 
23-30 

26OO 
3OOO 
3500-4500 

US 

1  20 
140-180 

CHILD 

Age  o—  6  months 

7—  jc  Ibs 

4.2    4.O 

3OO—6OO 

i  gram  per  Ib. 

6-12   " 

I  C—  2O 

4.O 

6OO-8OO 

•2C—  4.O 

2  years 

2C 

36 

QOO 

4-2 

•3C 

•IJ. 

I2OO 

cc 

8     "     

CO    ' 

•?T 

28 

I4.OO 

60 

12       " 

7C    ' 

22 

I6OO 

75 

I  gram  proteid  =  4.1  calories 

i  gram  fat 
(i  gram  =  0.03527  oz.) 


i  gram  carbohydrates  =  4.1  calories 
9 . 3  calories 

(28  grams  =  i  oz.,  approximately) 


THE  COMPOSITION  OF  FOODS 


GRAMS 

NAMES  OF    FOODS 

BY 
WEIGHT 

COMMON 
MEASURES 

OR- 
IES 

PRO- 
TEIN 

FAT 

CARBO- 
HYD- 

MIN- 
ERAL 

RATES 

Foods  Containing  a  Large  Share 

of  Protein 

Milk  

8  OZ. 
8  OZ. 

a  glass 
a  glass 

1  60 

80 

7-5 
7-5 

9-5 
I. 

12. 
H-5 

.7 
.7 

Skimmed  milk  and  buttermilk 

Condensed  milk  j  SSSSlrf 

20  gms. 

a    heaping 
teaspoon 

70 

2. 
2. 

2. 
2. 

1  ! 

1.9 

(  Skim-milk  ) 
Cheese  •]  Cream         [•  

15  gms. 

one-inch 
cube 

70 

4-5 
4- 

2-5 

5- 

C.  C 

:'l 

3-8 

(  American    ) 

Eggs  (whole)  

co  gms 

one 

7C 

6  c 

"  (yolk)  .  . 

i  c  cms 

one 

re 

*c 

• 

Beef  tea  

5oz. 
50  gms. 

a  teacup 
a  heaping 
tablespoon 

:>:> 

5-20 

35 

II. 

• 

•5 

•5 

.8 

t"  i    (  lean  (cod,  flounder)  ) 
*lsh  ?  fat  (shad,  salmon)     J  " 

6,'i 

[ 

(  lean.              ) 
Meat  -j  medium  fat   [•  

50  gms. 

a  slice    J 

70 
ico 

n-5 

2-5 

9- 

::::l 

•7 

(fat                 ) 

5x3^4      1 

200 

8  c 

iH 

\ 

Oysters 

16  gms. 

one 

8 

i. 

.2 

•5 

i.i 

266 


THE    COMPOSITION   OF    FOODS 


NAMES   OF    FOODS 

AMT. 
BY 
WEIGHT 

COMMON 
MEASURE 

CAL- 
OR- 
IES 

GRAMS 

% 

MIN- 
ERAL 

PRO- 
TEIN 

FAT 

CARBO- 
HYD- 
RATES 

Foods  Containing  a  Large  Share 
of  Fat 

(  thin  (20  per  cent.)  ) 
Cream  }  thick  (40  percent.)! 

Butter     

16  gms. 
10  gms. 
40  gms. 

4  gms. 
25  gms. 

25  gms. 

40  gms. 
7  gms. 
40  gms. 

30  gms. 
8  oz. 

8  oz. 
25  gms. 
95  gms. 
35  gms. 
30  gms. 
35  gms. 
35  gms. 
25  gms. 
35  gms. 
8  gms. 
50  gms. 

a  table- 
spoon 
a  pat  or 
ball 
a    heaping 
tablespoon 
a  teaspoon 
a    heaping 
tablespoon 

one  slice 

4x4xr 

one 
one 
a    heaping 
tablespoon 
one 
a  soup 
plate 
a  soup 
plate 
a    neaping 
tablespoon 
one 
medium 
a    heaping 
tablespoon 
a    heaping 
tablespoon 
a    heaping 
tablespoon 
a    heaping 
tablespoon 
a    heaping 
tablespoon 
a    heaping 
tablespoon 
a    heaping 
teaspoon 
a    heaping 
tablespoon 

30 
60 

80 

135 

37 
165 

70 

H5 

30 

35 

IIO 

75 
160 

25 
90 
40 
35 
35 
40 

20 
20 

33 
160 

•5 

•5 

l-S 

1: 

8-5 
9- 
4. 

Jt 

II. 

•5 
3- 
.6 

Jce  Cream                          

Olive  oil 

Almonds 

5- 

2-3 

3-5 
•5 
i. 

3- 

2-5 

5-5 

2. 
I. 
I. 

2-5 

I. 

•5 

•5 

13-5 

•5 

i. 

•5 

•5 
i. 

4-5 
•5 

.1 

.  rj 

4-5 

13- 

22.5 
5- 
7- 

23- 
14- 

24. 
4- 

20. 

6. 

7- 
6-5 
5- 
3-5 
3-5 
8. 

38.5 

i.i 
i.i 

2.1 
2.1 

I. 

2.1 

i-5 

i-3 

.8 
.8 

•  4 

•7 

I.O 

1-7 

•  4 

0.0 

Foods  containing  a  Large  Share 
of  Carbohydrates 

Bread,  white  or  graham  
Vienna  roll                        

Crackers  (Uneeda)           

Cereals,  cooked  moist 

Shredded  wheat 

Gruels  (cereal) 

Thickened  or  Cream  Soups.  .  . 
Macaroni           

Potato,  boiled  or  baked  

Potato,  mashed 

Rice,  boiled                      .    .    . 

Corn,  canned      

Peas,  fresh 

Lima  beans,  canned 

Squash 

Sugar 

Fruit  ielly,  sweetened  

267 


THE    COMPOSITION   OF   FOODS 


NAMES   OF   FOODS 

AMT. 
BY 
WEIGHT 

COMMON 
MEASURE 

CAL- 
OR- 
IES 

GRAMS 

% 

MIN- 
ERAL 

PRO- 
TEIN 

FAT 

CARBO- 
HYD- 
RATES 

Honey  

10  gms. 
40  gms. 
20  gms. 
45  gms. 

120  gms. 
45  gms. 
loo  gms. 
130  gms. 
loo  gms. 
loo  gms. 

a    heaping 
teaspoon 
a    heaping 
tablespoon 
a  slice 

2X4xf" 

a    heaping 
tablespoon 

one  me- 
dium size 
a    heaping 
tablespoon 
one  me- 
dium size 
one  me- 
dium size 
a   medium 
saucerful 
a   medium 
fsaucerful 

33 
55 
75 
80. 

75 
70 

100 

70 
40 
350 

8. 
9- 
13- 
13- 

17- 
i6-S 

22. 
IS- 

7-5 
76. 

0.0 

•5 
i-S 

2. 

Custard 

2-5 

i-S 

2. 

•  5 

15 

i.i 

2-5 

•5 

2. 
2. 

•  5 
•5 
•5 

•  5 
3- 

Sponge  cake 

Pudding  . 

Foods  Valuable  for  Bulk  and 
Mineral  Matter 

Apple,  pear  

Apple  sauce  

Banana 

.6 

4 
.6 

.2 
2.2 

•  9 
.8 

Orange 

Strawberries  .    . 

Dried  figs,  dates,  raisins.  .  .    . 

Cabbage  

Lettuce  

Radishes 

Spinach 

2.1 

.8 
'5 

Celery  .... 

Onions  

». 

268 


270          THE  CASE-SYSTEM  OF  HYGIENE 


CASE  49 

The  Rockefeller  Commission  estimates  that  there  are  two 
million  people  in  the  southern  states  of  the  United  States  who 
have  a  certain  disease.  These  people  are  not  sick  in  bed? 
but  they  go  about  listlessly  half  doing  their  work;  looking 
pale,  weak,  and  stupid.  Many  of  them  are  stunted  in 
growth.  Most  of  them  are  poor.  They  do  not  live  as  long 
as  other  people.  They  are  generally  backward.  This 
costs  the  south  a  great  deal. 

What  disease  do  these  people  have? 


272          THE  CASE-SYSTEM  OF  HYGIENE 

DISCUSSION — CASE  49 

These  people  have  hookworm.  Hundreds  of  small  worms 
live  in  the  intestine  of  each  victim.  You  can  see  the  effect. 
Hookworm  costs  the  south  millions  of  dollars  and  thousands 
of  lives  every  year. 

Many  of  the  eggs  of  the  worms  get  into  the  intestinal 
discharges.  The  disease  is  spread  therefrom  when  the  dis- 
charges are  not  properly  disposed  of  in  a  sewer  or  in  a 
sanitary  privy.  If  the  eggs  be  deposited  on  the  soil,  as  often 
happens  among  these  people  seventy-five  per  cent,  of  whom 
have  no  privies,  the  worms  hatch  out  and  get  into  people's 
bodies  by  burrowing  through  bare  feet.  They  also  enter  the 
ody  in  food  and  in  water. 

It  is  easy  to  cure  the  disease  by  using  the  drugs  thymol 
and  chenopodium.  Like  all  drugs,  these  drugs  should  be 
given  only  under  the  supervision  of  a  doctor.  No  liquor 
or  patent  medicine  should  be  used  at  the  same  time  because 
it  may  cause  poisoning.  Otherwise,  the  treatment  is  safe. 

It  is  hard  for  one  to  comprehend  just  how  real  a  case  of 
hookworm  is  until  after  the  thymol  treatment  he  has  seen 
a  weak,  pale,  stunted,  stupid  patient  freed  of  hundreds 
of  the  small  worms  wriggling  and  seething  in  a  mass  and  then 
has  seen  the  patient  wax  pink  and  strong;  grow  and  become 
bright  and  lively. 

The  disease  can  be  prevented  by  having  suspected  cases 
examined  by  a  doctor  and  having  sewage  properly  disposed 
of.  To  secure  suspected  cases  all  of  these  two  million 
people  have  to  be  taught.  Although  very  few  of  them  can 
read  the  south  is  doing  this  rapidly. 


Diagnosis 
Symptoms 


Cause    . 
Treatment 

Preventive 

Treatment 
Prevention 


BOOK  SEVEN  273 

SUMMARY  OF  PRACTICAL  POINTS 

.   Hookworm  disease. 
.   General  Backwardness. 

A.  Listlessness 

B.  Shiftlessness 

C.  Pallor 

D.  Weakness 

E.  Stupidity 

F.  Lack  of  growth. 

G.  Poverty 

H.  Shortness  of  life. 
.   Hookworm 

.    I.  Thymol  or  Chenopodium. 
2.  Avoiding  alcohol  at  time  of  treatment. 

.   Thymol  or  Chenopodium. 
.   Proper  disposal  of  sewage. 


GLOSSARY 


KEY  TO  PRONUNCIATION 

as  in  mate,  senate,  fat,  arm,  all,  ask,  what,  care. 
"     mete,  event,  met,  her,  there,  obey. 
"     sheet. 

lice,  idea,  it,  sir,  machine. 

"     hold,  obey,  not,  move,  wolf,  son,  horse,  work, 
food,  foot. 

use,  unite,  up,  fur,  rule,  pull, 
fly,  myself,  baby,  myrrh, 
author. 

saw.  ew 

boy.  ou 

c    (unmarked)  as  in  call;    9 
ch  (unmarked)     "     child;  ch 


e 

ee 

i 

o 

oo 

u 

y 

au 

aw 

oy 


g    (unmarked)  go;      g(=j) 

ng         as  in  ring.  Q(  =  ng) 

s(  =  z)      "     is.  si(  =  sh) 

th  (unmarked)  as  in  thin;  th 
x    (unmarked)     "     vex;    x(  =  gz) 


as  in 

new. 

01 

" 

out. 

ow 

" 

mice, 
chaise; 

ci  ( 

" 

cage. 

n 

ink. 
tension; 
then. 

ph( 
ti  ( 

t{ 

exact. 

sh) 


as  in  boil. 
"     cow. 
"     gracious. 
"     school. 


=  0     as  in  phantom 
) 


=  sh) 


vision, 
motion. 


ab'  scess  (ab'-ses) 

a  dul'  ter  ate 

an  ti  sep'  tic  (an-te-sep'-tic) 

an-ti-tox'-m  (an-te-toxs'-in) 

ar'  is  tol 

at'  ro  phy  waste  away 

ba  cil'  lus  (ba-sil'-us) 

B6r'  det  (Bor'-day) 

bron  eh!'  tis  (brong-ki'-tis) 

bu  bonr  ic  (bu-bon'-ik) 

caff'  e  ine  (kaf'-a-ine) 

cer'  ti  fied  (cer'-ti-fld) 

cham'  ois  (sham'-mi) 

chol'  er  a  (kol'-er-ah) 

cor'  ne  a  (kor'-nee-ah) 

de  form'  i  ty  (de-form-a-te) 


de  li'  ri  urn  ^ 

de  range'  ment  (de-rang'-ment) 
di  arr  hoe'  a  (di-ar-e'-ah) 
diph  the'  ri  a  (dip-the'-re-ah) 
dys  pep'  si  a  (dis-pep-se-ah) 
ep  i  dem'  ic  (ep-e-dem'-ik) 
ep  i  lep'  tic  (ep-e-lep'-tik) 
Fahr'  en  heit  (fair'-en-hite) 
fu'  sel  (fuze'-l) 
glan'  ders 

groin'  the  crease  between  the  abdo- 
men and  thigh 
hem'  orr  hage  (hem'-or-aj) 
he  red'  i  ty  (he-red'-it-e) 
hy  po  chlo'  rite  (hi-po-klo'-rit) 
im  mune'  (im-un') 


GLOSSARY 


im  pair'  ed 
m-ci'-sed  (in-sizd') 
in  cu  ba'  tion  (in-ku-ba'-shun) 
in  di  ges'  tion  (in-di-ies'-chun) 
in  fee'  tion  (in-fek'-shun) 
in  flamm  a'  tion  (in-flam-a'-shun) 
V  sol  ate  (I'-so-lat) 
lar'  ynx  Jlar'  inks) 
lep'  ro  sy  (lep'-ro-se) 
lym  phat'  ics  (limf-at'-iks) 
mal  a'  ri  a  (mal-a'-re-ah) 
men  inr  ges  (men-in'-jez) 
men  in  gi'  tis  (men-in-ji'-tis) 
mod'  I  fied 

mor'  phine  (mor'-fin) 
nic'  6  fine  (nik'-o-ten) 
ni'  trate  (ni'-trat) 
o  paque'  (o-pak') 
par'   a  lyze  (par'-ah-li'z) 
par  al'  ys  is  (par-al'-is-is) 
par'  a  site  (par'-ah-sit) 
pas'  teur  ize  (pas'-tur-iz) 
per  ox'  ide  (per-oks'-id) 
plague  (plag') 

pneu   mo   cocc'    us    (nu-mo-kok'- 
kus) 


pneu  mo'  m  a  (nu-mo'-ne-ah) 

pre  cau'  tion  (pre-cau'-shun) 

pre  dis'  pose  (pre-dis'-poz) 

pus 

quar'  an  tine  (kwor'-an-ten) 

qui'  nine  (kwi'-nin) 

re'  ere'  ate  (re'-cree'-ate) 

san  it  a'  tion  (san-it-a'-shun) 

sep'  sis 

sep'  tic  (sep'-tik) 

spu'  turn 

ster'  ile  (ster'-il) 

steth'  o  scope  (steth'-o-skop) 

strep  to  coc  cus  (strep-to-kok'-kus) 

strych'  nm  (strik'-nm) 

tet'  an  us 

the'  i'ne  (tay-ine) 

tmct'  Ore  (tingk'-tur) 

ton'  sil 

tra  cho'  ma  (tra  ko'-mah) 

tu  ber'  cu  lar  (tu-bur'-ku-lar) 

tu  ber'  cu  lin  (tu-bur'-ku-lin) 

tu  ber  cu  16'  sis  (tu-bur-ku-lo'-sis) 

ty'  phoid  (ti'-foid) 

ty'  phus  (ti-fus) 

vac  cine  (vak'-sen) 


INDEX 


A*  means  a  case  of 


Abnormal  &  normal,  112 
Abscess  of  neck,  21 

of  throat,  89,  *92 
Accidents,  factory,  168 

motor,  166 
Alcohol  &  accidents,  *IQ2 

&  adulteration,  *io/6 

&  crime,  *2i6 

&  families,  *2io 

&  heredity,  *2io 

&  insanity,  *2I2 

&  long-life,  *202 

&  nation,  210 

&  school-children,  *22O 

&  tuberculosis,  *2o6 
Antitoxin,  54 
Aristol,  185 
Balanced  ration,  240 
Barley-water,  240 
Bass,  129 

Bats  &  Malaria,  130 
Black-death,  135 

Blood  test  for  whooping  cough,  49 
Boards  of  Health,  49 
Bordet,  44 

Brain  &  nicotine,  230 
Bubonic  plague,  *I32 

&  fleas,  134 

&  glands,  134 

&  rats,  134 
Carriers  of  colds,  15 

of  typhoid,  255 
Chamois  skin,  185 
Chill,  32,  34 
Cholera,  *242 

&  sewage-disposal,  245 

&  sewers,  245 

&  vaccines,  245 
City  dwellers,  85 
Cleanliness,  141 
Clothes,  dirty,  159^ 


Cold-in-head,  12,  1 8 
Complications  with  measles,  30 
Consumption,  *68,  *74 
Contagious  hospital,  58 
Cornea  &  trachoma,  178 
Criminals,  216 
Criss-crossing,  60 
Crowding,  82,  84 
Cross^infection,  60 
Crossings,  166 
Culture,  55 
Dairy,  86,  92 
Diarrhoea,  summer,  238 
Diphtheria,  *52 

&  measles,  30 
Dogs  &  alcohol,  210 
Drinking-cup,  common,  179 
Drugs,  habit-forming,  190,  230 
Ears  &  measles,  30 

&  scarlet  fever,  35 
Examinations  by  a  doctor,  112 
Eyes,  inflammation  of,  176 

trachoma  of,  178 
Eye-lids,  aching,  176 
Factories,  84,  170 
Filters,  250 
Flexner's  serum,  no 
Flies,  236 

Florence  Nightingale,  *2 
Foot  and  mouth  disease,  146 
Foreign  body  in  wound,  174 
Gland  infected,  *i8 
Glanders,  114 

Harvard  and  Who's  who,  230 
Headache  tablets,  252 
Heart,  35 

Hemorrhage,  tubercular,  *74 
Hodge,  210 
Horse-manure,  236 
Horses  and  Glanders,  114 
Hospital  contagious,  *58 


H 


INDEX 


Housing,  82 

Housing  &  tuberculosis,  72,  82 
Hypochlorite,  infant-feeding,  241 
Incubation  period,  60 
Infantile-paralysis,  104 
Infection  of  finger,  *I56,  *i6o 

of  toes,  164 

Inflammation  of  eye,  182 
Insane  asylums,  214 
Insanity,  214 
Inspectors,  factory,  170 
Intestines  &  germs,  240 

&  typhoid,  254 
Isolation,  61 

home,  61 
Jenner,  153 
Joints,  35 
Knee-jerk,  no 
Lice,  140 

Life  Insurance  Companies  &  alcohol,  204 
Lock-jaw,  174 
Lymphatics,  21 
Malaria,  *I26 
Manure,  236 
Manure-pile,  234 
Marine  hospital  service,  148 
Massage,  106 
Measles,  *24,  *28 

&  complications,  30 

&  diphtheria,  30 

&  tuberculosis,  30 
Medicines,  patent,  256 
Meninges,  no 
Meningitis,  spinal,  *io8 
Mice,  135 

Mince-pie  factory,  168 
Milk  &  bacteria,  94 

certified,  241 

for  baby,  240 

&  ice,  95 

Inspection,  94 

modified,  240 

&  pasteurization,  95 

pure,  94 

&  scarlet  fever,  35 
Milker,  *86,  *92 
Mosquitoes,  128, 
Motor-cycle  accident,  *i66 
Moving-picture  theatre,  18 
New  Orleans,  134 
Nicotine  &  brain,  230 
Noises,  84 


Normal  &  abnormal,  112 
Odor,  84 
Ophthalmia,  182 
Panama,  larvacide,  130 

&  malaria,  130 
Paralysis,  infantile,  104 
Pasteurization,  95 
Patent  medicines,  256 
Philippine  Islands  &  smallpox,  153 
Plague,  132 
Pneumococcus,  100 
Pneumonia,  *g8 

&  alcohol,  102 
Privies,  250 
Public  buildings,  22 
Public  servant,  18,  22 
Pus  in  chest,  *ioo 

in  ear,  101 

in  glands,  101 

in  sinuses,  101 
Quarantine,  245 
Quinine,  129 
Ration,  balanced,  240 
Rats,  135 
Research,  102 
Rubber-gloves,  160 
Russians  &  typhus,  140 
Sanatarium,  76 
Scarlet  fever,  *32,  *38 

carriers  of,  34 

complications,  35 

&  ears,  35 

&  heart,  35 

&  joints,  35 

&  kidneys,  35 

&  milk,  34 

symptoms  of,  34 

vaccine  for,  40 

walking,  *38,  *I56,  *i6o 
Sepsis,  *i66,  *i68,  "172 
Septic  sore  throat,  *86,  *92 
Servia  &  typhus,  140 
Serum  &  tetanus,  236 
Sewage,  disposal,  245,  250 
Sewers,  245 
Silver-nitrate,  185 
Small-pox,  *I5O 
South  Africa  &  tobacco,  224 
Spinal  cord,  106,  no 
Spinal  fluid,  no 
Sputum  &  tuberculosis,  71 
Standing,  at  school,  230 


INDEX 


Stethoscope,  112 

Streams,  pollution  of,  245,  250,  255 

Streptococcus,  94 

Tenements,  84 

Tetanus,  serum,  174 

Theine,  190,  230 

Thorn,  172 

Tobacco  &  soldiers,  *224 

&  wound,  170 

&  students,  *228 

&  success,  230 
Towel,  common,  179 
Trachoma,  176 
Troughs,  for  water,  116 
Trout  &  malaria,  130 
Tuberculin,  30 
Tuberculosis 

&  alcohol,  65,  70 

&  exercise,  76 

&  hemorrhage,  76 

&  measles,  30 

&  most  people,  7 1 

of  lymph  glands,  *78,  88 

symptoms  of,  76 

whooping  cough,  48 
Turpentine,  234 


Typhoid,  bacillus,  255 

&  flies,  255 

&  Mary,  255 

&  ulcers,  254 

&  vaccine,  255 

&  walking,  255 
Typhus  fever,  "138 

&  lice,  140 
Vaccination,  153 

shield,  155 

&  tetanus,  154 
Vaccine  &  typhoid,  255 
Ventilation,  of  public  buildings,  22 

&  tuberculosis,  71,  84 
Wash-bowl,  common,  179 
Water,  244,  248 

&  troughs,  116 

&  typhoid,  255 
Wells,  248,  251 
Whooping-cough,  *42,  *^.6 

&  tuberculosis,  48 
Worms,  78 
Wound  &  tobacco,  170 

of  hand,  *ijo 

punctured,  *I72 
Yale  &  tobacco,  228 


VAN  REES  PRESS 
NEW  YORK    CITY 


• 


YB  65518 


UNIVERSITY  OF  CALIFORNIA  LIBRARY 


